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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': 'alcohol withdrawal', 'medical_history': ['- Alcoholism with history of delirium on withdrawals', '- alcoholic hepatitis', '-peptic ulcer disease s/p partial gastrectomy in ___', '-CAD s/p MI in ___', '-EtOH induced cardiomyopathy', '-Paroxysmal atrial tachycardia ', '-GERD', '-Anxiety', '-hyponatremia', '-COPD', '-Chronic anemia', '-Degenerative joint disease', '-back pain status post back surgery', '-reported admissions for atypical CP', '-hearing loss', '-HLD', '-prior rhabdomyalysis', '-microhematuria'], 'family_history': 'Father died at age ___ of heart disease. His sister has a \nhistory of CAD at age ___, and his mother also has a questionable \nhistory of CAD.', 'present_illness': 'This is a ___ man with a PMH of alcoholism, alcohol withdrawl, \nmeningitis, cognitive impairment and coronary artery disease, \nwho presents to an OSH with dizziness, left sided weakness and \nleft sided chest pain radiating to his jaw and arm. He was \nlethargic and agitated with an altered mental status, and was \nunable to provide a history. A work-up for MI was performed at \nthe OSH and was negative, but troponin levels were elevated at \n0.05. The patient was also hyponatremic with a Na of 128. The \nurine tox screen was also positive for tricyclic \nantidepressents, although the patient does not have a history of \nTCA use. The head CT at the OSH showed possible lacunar \ninfarction in the right anterior capsule. Per verbal report \nfrom a nurse at the OSH, prior to transfer, the patient had \nbecome extremely agitated and was requiring security.\n\nOn transfer (___), he was admitted to the neurology service \novernight, for evaluation of possible stroke. He is known to \ncurrently abuse alcohol (confirmed by his PCP) and did not \nreceive benzodiazepines for prophylaxis prior to transfer. He \ndid not cooperate fully with neurologic exam but showed no sign \nof motor deficits and was quite dextrous and agile in tearing \nout his IV and snapping the tubing. He walked unassisted. Head \nCT here failed to show any right-sided abnormality; it was \nremarkable only for a chronic left-sided \nlacune. He was found to be tremulous with tongue fasciculations. \nEEG showed a normal, 10-Hz background rhythm and no \nepileptogenic features. He was felt to be in alcohol withdrawal \nand started on benzodiazepines and transferred to medicine.', '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': '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 Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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}]}, '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': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': '65', 'valuenum': 65.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '___', 'valuenum': 0.4, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '34', 'valuenum': 34.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.30', 'valuenum': 1.3, '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': '0.6', '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': 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': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78.0', 'valuenum': 78.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, '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': '4.08', 'valuenum': 4.08, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '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': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.57', 'valuenum': 0.57, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.97', 'valuenum': 6.97, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '48.5', 'valuenum': 48.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 93.0, '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': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . Estimated GFR = >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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '154', 'valuenum': 154.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '8', 'valuenum': 8.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.47, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90.0', 'valuenum': 90.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, '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': '202', 'valuenum': 202.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, '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': 0.0, 'ref_range_upper': 149.0, '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': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '154', 'valuenum': 154.0, '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': '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': '48.6', 'valuenum': 48.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.2, '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': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'STAT', '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': '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': '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', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.1, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, '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}], 'exams': 'Vitals: T: 98.1 P: 92 R: 20 BP: 154/91 SaO2: 100%2L\nGeneral: Awake, NAD, very agitated\nHEENT: NC/AT, MMM, no lesions noted in oropharynx \nNeck: Supple, no carotid bruits noted, and no JVD\nPulmonary: diffuse wheezes bilaterally, but increased at bases\nCardiac: nl S1S2, but distant heart sounds, no JVD\nAbdomen: soft, NT/ND, normoactive bowel sounds\nExtremities: no edema noted\n.\nNeuro exam:\nMental status: Patient is alert and oriented x 1 (person). \nKnows month and that he is in the hospital. \nCN exam:\nI: not tested\nII,III: visual field is intact. pupils round and reactive to \nlight.\nIII,IV,VI: no ptosis or nystagmus. does not have conjugate gaze \nand does not track with finger\nV: V1-V3 sensation intact symmetrically, able to grimace\nVII: able to move face symmetrically\nVIII: wearing hearing aid in the L ear. able to hear finger \nrubs on both sides.\nIX,X: appears to elevates palate symmetrically, uvula midline\nXI: noncooperative\nXII: midline tongue on pertrusion\n.\nMotor exam: weakness on left side compared to right, both in arm \nand leg; patient has a widened gait\n.\nPHYSICAL EXAM NOT NOTABLY CHANGED AT TIME OF DISCHARGE EXCEPT \nRESOLUTION OF AGITATION', 'diagnoses': [{'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E042', 'desc': 'Nontoxic multinodular goiter'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6832', 'desc': 'Body mass index [BMI] 32.0-32.9, adult'}], 'summary': "___ 01:30AM BLOOD WBC-6.0 RBC-3.87* Hgb-10.9*# Hct-32.6* \nMCV-84# MCH-28.2# MCHC-33.5 RDW-18.4* Plt ___\n___ 06:50AM BLOOD WBC-8.1 RBC-3.57* Hgb-10.0* Hct-30.4* \nMCV-85 MCH-27.9 MCHC-32.8 RDW-16.4* Plt ___\n___ 01:30AM BLOOD ___ PTT-28.4 ___\n___ 01:30AM BLOOD Glucose-94 UreaN-5* Creat-0.8 Na-132* \nK-4.2 Cl-97 HCO3-23 AnGap-16\n___ 06:50AM BLOOD Glucose-68* UreaN-15 Creat-0.7 Na-134 \nK-5.2* Cl-100 HCO3-23 AnGap-16\n___ 01:30AM BLOOD ALT-8 AST-17 LD(LDH)-136 AlkPhos-95 \nTotBili-0.7\n___ 07:30AM BLOOD ALT-16 AST-53* LD(LDH)-407* CK(CPK)-131 \nAlkPhos-78 TotBili-0.2\n___ 01:30AM BLOOD Lipase-18\n___ 09:15PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 07:30AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 01:30AM BLOOD Albumin-4.2 Calcium-9.0 Phos-3.7 Mg-1.9 \nIron-24*\n___ 06:50AM BLOOD Calcium-9.7 Phos-4.1 Mg-2.0\n___ 01:30AM BLOOD calTIBC-378 Ferritn-41 TRF-291\n___ 06:15AM BLOOD VitB12-344 Folate-8.8\n___ 06:20AM BLOOD Triglyc-75 HDL-89 CHOL/HD-2.0 LDLcalc-75\n___ 01:30AM BLOOD TSH-0.42\n___ 01:30AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-POS\nECHO\nThe left atrium is normal in size. There is mild symmetric left \nventricular hypertrophy with normal cavity size. There is severe \nglobal left ventricular hypokinesis (LVEF = ___ %). Tissue \nDoppler imaging suggests a normal left ventricular filling \npressure (PCWP<12mmHg). Right ventricular chamber size and free \nwall motion are normal. The aortic root is moderately dilated at \nthe sinus level. The ascending aorta is mildly dilated. The \naortic valve leaflets (3) are mildly thickened but aortic \nstenosis is not present. The mitral valve appears structurally \nnormal with trivial mitral regurgitation. The estimated \npulmonary artery systolic pressure is normal. There is an \nanterior space which most likely represents a fat pad. \nIMPRESSION: Mild left ventricular hypertrophy with severe global \nleft ventricular systolic dysfunction. \nCT HEAD WITHOUT CONTRAST (___): There is no intracranial \nhemorrhage, shift of normally midline structures, or evidence of \nacute major vascular territorial infarct. Mild periventricular \nand subcortical white matter hypointensitiesare unchanged. \nProminence of the ventricles out of proportion to sulcal \nprominence demonstrates no significant short interval change. \nAtherosclerotic cavernous carotid calcification is noted \nbilaterally. No fracture is identified. The mastoid air cells \nappear well aerated. Mild mucosal thickening is noted in the \nmaxillary sinuses bilaterally with a right maxillary mucous \nretention cyst partially visualized. Mild sphenoid and frontal \nsinus mucosal thickening and mild ethmoid air cell mucosal \nthickening is noted. Ill-defined heterogeneous soft tissue in \nthe right external auditory canal likely represents cerumen. \nIMPRESSION: No intracranial hemorrhage or edema. \nMRA OF THE HEAD (___): \nThe head MRA is somewhat limited by motion. There is an \napproximately 3 mm \nprotuberance seen in relation with the perimesencephalic portion \nof the right posterior cerebral artery. This is suspicious for \nan aneurysm. In addition, there is irregularity of the flow \nsignal at the bifurcation of right middle cerebral artery. No \nother distinct aneurysms or occlusions are identified. \nIMPRESSION: Question of a 3-mm aneurysm in relation with the \nperimesencephalic portion of right posterior cerebral artery and \nprobable \nstenosis or artifact at the bifurcation of right middle cerebral \nartery. CT angiography is recommended for further evaluation. \nFindings were conveyed to the clinical team at the time of \ninterpretation of this study of ___ at 1 p.m. \nC-spine MRI (___\nThere is evidence a prior C5-C6 anterior fusion. There is \nstraightening of \nthe normal cervical lordosis. Within limits of this examination, \nno definite evidence for a cord contusion is seen, although the \nsagittal T2-weighted images are motion degraded. There does not \nappear to be a large epidural hematoma. No definite evidence for \nligamentous injury is seen. Multilevel cervical spondylosis is \nseen with central canal stenosis from C3 through C6, which is \nincompletely assessed due to motion degradation of the axial \nimages. \nIMPRESSION: \nExtremely limited study due to motion. No definite evidence for \nposttraumatic sequela in the cervical spine. \nThere is a 2.5-mm aneurysm seen at the right PCA. There is a \npoorly \ncharacterized area at the left PCA which likely represents \nvolume averaging image error but may be a small aneurysm. Would \nrecommend followup of this area with future imaging. There is a \nsmall focus of calcification noted at the right vertebral \nartery. Otherwise, the carotid and vertebral arteries are patent \nwith no evidence of stenoses. The major intracranial arteries \nare patent with no evidence of stenoses. \n \nCONCLUSION: \n1. Right PCA aneurysm measuring approximately 2.5 mm. \n2. Poorly visualized area in the left PCA, which likely \nrepresents volume \naveraging artifact but which may represent a small aneurysm. \nFollowup imaging is recommended. \n3. Left lacunar infarct in the area of the globus pallidus. \n4. Bilateral ventricular enlargement and sulcal prominence \nconsistent with \nage-related changes. \nNCHCT after fall (___\nThere is no intracranial hemorrhage. There is no mass, mass \neffect, edema, or evidence of acute vascular territorial \ninfarction. The ventricles and sulci are unchanged in size and \nconfiguration. Left basal ganglia lacunar infarct is unchanged. \nThere is no fracture. \nIMPRESSION: No intracranial hemorrhage. No significant change \nfrom ___.\nOn admission to the medicine service, the pt was treated with \nvalium on a CIWA sliding scale. His agitation and internal \nstimulation resolved within ___ days and valium was \ndiscontinued. Psychiatry and neurology re-assessed the pt once \nhis delirium resolved and concluded that there was an underlying \ndementia, likely ___'s Syndrome secondary to significant \nalcohol abuse. The pt had multiple somatic complaints including \nleft sided weakness/pain and hematemesis; due to lack of \ncorroboration and inconsistencies, many of these complaints were \ndeemed to be a consequence of confabulation. On more than one \noccasion, pt stated that he could not move his left side and was \nshortly thereafter seen moving his left side. Even after \ndelirium resolved, pt frequently made odd comments surrounding \nhis medical history: such as being shot four times before coming \nto hospital. It appears that the pt is tangential and \nperseverative at baseline.\n.\nPt had several falls while on the inpt service. These were \nlikely the consequence of his very unstable wide-based gait. He \nclaimed to his head during some of these falls, but his head \nnever showed external signs of trauma, and serial CT scans of \nthe head showed no change.\n.\nAn MRA showed a lesion suspicious for a right PCA aneurysm. This \nwas confirmed with a CTA (2.5mm aneurysm). Neurology reccommends \nthat the pt get rescanned every year for the next ___ years, and \nif it remains stable, then every ___ years thereafter.\nCervical MRI showed stenois of the central canal, but not to a \ndegree requiring intervention.\n.\nPt did complain of bright red blood per rectum that was not \nwitnessed, but his hematrocrit never dropped. His guiaic on the \nday of discharge was positive, although no frank blood seen on \nrectal exam. Pt should have a colonoscopy as an outpt.\n.\nPt appears to have chronic stable anemia, hyponatremia, and \nCOPD. COPD was managed with albuterol and atrovent nebulizers \nprn, but the pt raely asked for them and was frequently wheezy. \nHyponatremia is stable and likely due to chronic alcohol abuse.\n.\nPt was ruled out for myocardial infarction/ischemia at OSH. \nTroponins were drawn during this admission as well because of \ncomplaints of chest pain. All troponins were normal and there \nwere no changes on EKG.\n.\nBriefly, Mr. ___ is a ___ year old man with PMH of alcoholism, \ncoronary artery disease and MI who presents to an outside \nhospital for dizziness, left sided weakness and left sided chest \npain that radiates to his head and shoulder. Patient was \ntransferred to the BI and admitted to medicine for acute \ndelirium thought to be secondary to alcohol withdrawal. The \npatient was ruled out for stroke numerous times and CTA of the \nhead revealed a 2.5mm aneurysm which must be followed with \nrepeat scans as above. The pt will also require outpt \ncolonoscopy."}}
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{'final_diagnoses': ['Alcohol withdrawal ', 'Cervical Canal stenosis ', 'Alcoholic cardiomyopathy ', "Korsakoff's Syndrome ", 'Alcohol Abuse ', 'Coronary artery disease '], 'procedures': ['none'], 'visit_summary': "On admission to the medicine service, the pt was treated with \nvalium on a CIWA sliding scale. His agitation and internal \nstimulation resolved within ___ days and valium was \ndiscontinued. Psychiatry and neurology re-assessed the pt once \nhis delirium resolved and concluded that there was an underlying \ndementia, likely ___'s Syndrome secondary to significant \nalcohol abuse. The pt had multiple somatic complaints including \nleft sided weakness/pain and hematemesis; due to lack of \ncorroboration and inconsistencies, many of these complaints were \ndeemed to be a consequence of confabulation. On more than one \noccasion, pt stated that he could not move his left side and was \nshortly thereafter seen moving his left side. Even after \ndelirium resolved, pt frequently made odd comments surrounding \nhis medical history: such as being shot four times before coming \nto hospital. It appears that the pt is tangential and \nperseverative at baseline.\n.\nPt had several falls while on the inpt service. These were \nlikely the consequence of his very unstable wide-based gait. He \nclaimed to his head during some of these falls, but his head \nnever showed external signs of trauma, and serial CT scans of \nthe head showed no change.\n.\nAn MRA showed a lesion suspicious for a right PCA aneurysm. This \nwas confirmed with a CTA (2.5mm aneurysm). Neurology reccommends \nthat the pt get rescanned every year for the next ___ years, and \nif it remains stable, then every ___ years thereafter.\nCervical MRI showed stenois of the central canal, but not to a \ndegree requiring intervention.\n.\nPt did complain of bright red blood per rectum that was not \nwitnessed, but his hematrocrit never dropped. His guiaic on the \nday of discharge was positive, although no frank blood seen on \nrectal exam. Pt should have a colonoscopy as an outpt.\n.\nPt appears to have chronic stable anemia, hyponatremia, and \nCOPD. COPD was managed with albuterol and atrovent nebulizers \nprn, but the pt raely asked for them and was frequently wheezy. \nHyponatremia is stable and likely due to chronic alcohol abuse.\n.\nPt was ruled out for myocardial infarction/ischemia at OSH. \nTroponins were drawn during this admission as well because of \ncomplaints of chest pain. All troponins were normal and there \nwere no changes on EKG.\n.\nBriefly, Mr. ___ is a ___ year old man with PMH of alcoholism, \ncoronary artery disease and MI who presents to an outside \nhospital for dizziness, left sided weakness and left sided chest \npain that radiates to his head and shoulder. Patient was \ntransferred to the BI and admitted to medicine for acute \ndelirium thought to be secondary to alcohol withdrawal. The \npatient was ruled out for stroke numerous times and CTA of the \nhead revealed a 2.5mm aneurysm which must be followed with \nrepeat scans as above. The pt will also require outpt \ncolonoscopy.", 'medications_prescribed': ['1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', '2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '3. Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed.\nDisp:*50 Tablet(s)* Refills:*0*', '4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '5. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily).\nDisp:*30 Patch 24 hr(s)* Refills:*2*', '6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO once \na day.\nDisp:*30 Tablet(s)* Refills:*2*', '7. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device \nSig: One (1) Inhalation once a day.\nDisp:*qs * Refills:*2*', '8. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1) \nInhalation twice a day.\nDisp:*qs * Refills:*2*', '9. Prilosec 20 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*', '10. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily).\nDisp:*qs Adhesive Patch, Medicated(s)* Refills:*2*', '11. Albuterol 90 mcg/Actuation Aerosol Sig: One (1) Inhalation \nevery ___ hours as needed for shortness of breath or wheezing.\nDisp:*qs * Refills:*0*', '12. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day. \n \n13. 1 Nebulizer Kit\nas directed']}
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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': 'abdominal pain', 'medical_history': ['# EtOH abuse', '- alcoholic hepatitis ___', '- reported h/o DT, withdrawal seizures, but patient currently \ndenies', '# Asthma - four prior intubations per patient report', '# Oxycontin abuse, now on suboxone'], 'family_history': "Uncle died of EtOH cirrhosis. Multiple family members with \nasthma including mother and sister. No other known ailments on \nmaternal side, does not know about father's side.", 'present_illness': '___ yo male with history of alcoholic abuse, prior alcoholic \nhepatitis with evidence of portal hypertension presenting with 3 \ndays of abdominal pain. He reports that he relapsed again with \nalcohol and has been on a binge for two weeks. He has been \ndrinking 1++ liters of brandy and tequila per day. He reports \nthat he relapsed as a result of "stupidness" since he thought he \ncould have one drink but this led to many more. He has been \nsober for three months, and then ___ years prior to that. He \nis in a treatment program with Dr. ___ and is disappointed and \nashamed. He does not want his PCP to know about his relapse yet. \nHis last drink was at 4am yesterday morning. When he drinks, he \ndoes not take his suboxone. He has not had suboxone for the past \n___ days. He reports that he has felt sick including shaky, \nhot/cold, sweats, and as if ants are crawling all over his body. \nHe notes jittery hands, nausea, and vomiting of the alcohol he \ndrank. He denies hematemesis, diarrhea, or blood in his stools. \nHe has not eaten in ___ days or taken any of his medications. He \nreports abdominal pain across the top of his abdomen, pushing up \nto the epigastrium. This is worse with coughing. \nHe was recently admitted in ___ for similar complaints. His \nabdominal pain was felt to be likely alcohol induced. CT was \nunremarkable for any acute process. He was initially given iv \nmorphine then transitioned to oxycodone PO and then to suboxone. \nHe was treated with PPI BID, GI cocktail, and given IV fluids. \nHis diet was advanced without any difficulty. He also presented \nwith alcohol abuse with signs of alcoholic hepatitis. Abdominal \nCT showed signs of portal HTN with splenomegaly and dilated \numbilical vein. There was no clear evidence of cirrhosis. He \ndemonstrated some motivation to stop using Etoh. Discussions \nwith him indicate that the major impetus with Etoh use is sense \nof helplessness, particularly with his daughter (age ___ in \n___ - who he states is not making the right decisions. He \nis closely followed by his PCP (Dr. ___ in ___ and \nhas an outpt detox program in ___. He was not interested \nin SW assistance feeling that he is adequately supported through \nthe support system in place at the ___. \n\nIn the ED, triage vitals were pain 10 98.4 102 133/86 20 96% on \nRA. Exam was notable for guaiac positive yellow stool and lack \nof large volume ascites. EtoH level was 349, osm gap was 4. RUQ \nUS was done. He was given 15mg of Valium, a GI cocktail, zofran, \nmorphine, and 2L of NS. Most recent vitals prior to transfer: \n98.2 74 130/84 18 96% on RA. \nCurrently, he reports continued abdominal pain with jittery \nhands. He feels as if ants are all over his body.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'X1 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': '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': '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '5.1', 'valuenum': 5.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 209.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION:\nVS: 98.3 143/46 81 20 98% on RA\nGENERAL: uncomfortable appearing overweight male\nHEENT: mild scleral icterus, PERRL, EOMI, MM dry without lesions \n\nCARDIAC: RRR with no excess sounds appreciated\nLUNGS: wheezing throughout\nABDOMEN: +BS, soft, distended, tender over RUQ, epigastrium, and \nLUQ, unable to appreciate HSM given protuberant abdomen\nEXTREMITIES: wwp, no ___ edema, bilateral hands with tremor\nNEUROLOGY: A&OX3, CN ___ intact, strength symmetric, no \nasterixis \n\nDISCHARGE:\n97.7 143/86 73 18 95RA\nGENERAL: overweight male, sitting in bed, flat affect\nHEENT: mild scleral icterus, PERRL, EOMI, MM dry without lesions \n\nCARDIAC: RRR with no excess sounds appreciated\nLUNGS: CTAB no w/r/r, + ?spider angiomas appreciated on back \nABDOMEN: +BS, soft, distended, no masses, non tender to \npalpation\nEXTREMITIES: wwp, no ___ edema, bilateral hands with tremor\nNEUROLOGY: A&OX3, strength symmetric in UE & ___, no asterixis', 'diagnoses': [{'icd_code': '99859', 'desc': 'Other postoperative infection'}, {'icd_code': '6826', 'desc': 'Cellulitis and abscess of leg, except foot'}, {'icd_code': '73026', 'desc': 'Unspecified osteomyelitis, lower leg'}, {'icd_code': '04112', 'desc': 'Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': 'ADMISSION:\n___ 06:30PM BLOOD WBC-7.8# RBC-5.13 Hgb-14.6 Hct-42.7 \nMCV-83 MCH-28.4 MCHC-34.1 RDW-19.9* Plt ___\n___ 07:28PM BLOOD ___ PTT-39.2* ___\n___ 06:30PM BLOOD Glucose-86 UreaN-11 Creat-0.8 Na-145 \nK-3.7 Cl-99 HCO3-23 AnGap-27*\n___ 06:30PM BLOOD ALT-53* AST-173* AlkPhos-867* \nTotBili-6.0* DirBili-3.4* IndBili-2.6\n___ 06:30PM BLOOD Albumin-5.0\n___ 06:30PM BLOOD Osmolal-378*\n___ 06:30PM BLOOD ___\n\nIMAGING:\nRUQ US ___:\nIMPRESSION: \n1. Partly distended gallbladder without other signs specific for \nacute cholecystitis. \n2. Increased echogenicity of the liver with reversal of portal \nvenous flow, which was present on the prior ultrasound study. \n \nCXR ___:\nIMPRESSION: No acute cardiopulmonary process, no visualized free \nintraperitoneal air. \n\nCT ABDOMEN ___:\nIMPRESSION: \n1. No CT evidence of pancreatitis. \n2. Cirrhosis and portal hypertension with hepatomegaly, \nsplenomegaly and multiple large varices. \n3. Stable compression fracture or T7 and superior enplate \ncompression fracture of T9. \n\nDISCHARGE\n\n___ 06:36AM BLOOD WBC-4.8 RBC-4.19* Hgb-11.7* Hct-37.7* \nMCV-90 MCH-27.9 MCHC-31.0 RDW-19.4* Plt ___\n___ 06:36AM BLOOD Glucose-99 UreaN-10 Creat-0.6 Na-139 \nK-3.8 Cl-103 HCO3-26 AnGap-14\n___ 06:36AM BLOOD ALT-47* AST-100* AlkPhos-668* \nTotBili-2.9*\n___ 06:36AM BLOOD Calcium-9.6 Phos-3.8 Mg-1.___ year old gentleman with history of alcoholic abuse \ncomplicated by alcohol withdrawl requiring hospitalization in \nthe past & cirrhosis, narcotic abuse, and prior alcoholic \nhepatitis presenting with recurrent alcohol abuse and abdominal \npain.\nACTIVE ISSUES\n# Alcohol relapse with withdrawal: At admission the patient \nreported binge drinking for two weeks (+1L of brandy per day) \nwithout food or medications. He presented with anion gap \nmetabolic acidosis. Reports he was previously sober for 3 months \nbut decompensated after having problems with his daughte. \nReports that he has been drinking since age ___. Has been sober \nintermittently, with the longest period being ___ years. \nExpresses a lot of frustration and saddness about this \ndecompensation. Does not attend AA, but reports that he gets a \nlot of social support from the ___. Has been admitted to the \nhospital for withdrawal + 5 times, and at least once required \nICU admission. Denies any history of withdrawal seizures. \nMaintained with CIWA scale until patient no longer scored on \nCIWA. Continued MVI, thiamine, folate. Patient part of 12 step \nprogram and says he will attend meeting tomorrow.\n\n# Abdominal pain: Likely multifactorial - in part related to \nforceful vomiting, alcoholic hepatitis leading to capsular \nstretch of both the liver and spleen, also may be a component of \ngastritis or exacerbation of GERD or ulcerative disease as he \nhas not taken his PPI reliably recently. In house resumed PPI \nand added ranitidine and GI cocktails for comfort.\n\n# Anion Gap Metabolic Acidosis: Likely from alcohol abuse. \nClosed over course of admission.\n\n# Alcoholic hepatitis & Portal hypertension, with evidence of \ncirrhosis on CT and prior US:: With regards to alcohol hepatitis \nit appears mild with ___ less than 5, so there is role for \nsteroids at this time. Patient has outpt liver follow up.\n\n# Narcotics dependence: Suboxone initially held during valium \ndosing for withdrawl but then restarted suboxone on day of \ndischarge (one dose of 8mg SL)\n\nINACTIVE ISSUES\n# Asthma: Intermittent inspiratory and expiratory wheezing, but \nno evidence of respiratory distress. Continued advair and \nalbuterol. \n\nTRANSITIONAL ISSUES\n# F/u appointment with ___ in hepatology on \n___ biopsy to characterize degree of fibrosis\n# Given one dose of 8mg tab suboxone on day of discharge\n# CONTACT: mother ___ ___'}}
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{'final_diagnoses': ['Alcohol withdrawal'], 'procedures': ['None'], 'visit_summary': 'ACTIVE ISSUES\n# Alcohol relapse with withdrawal: At admission the patient \nreported binge drinking for two weeks (+1L of brandy per day) \nwithout food or medications. He presented with anion gap \nmetabolic acidosis. Reports he was previously sober for 3 months \nbut decompensated after having problems with his daughte. \nReports that he has been drinking since age ___. Has been sober \nintermittently, with the longest period being ___ years. \nExpresses a lot of frustration and saddness about this \ndecompensation. Does not attend AA, but reports that he gets a \nlot of social support from the ___. Has been admitted to the \nhospital for withdrawal + 5 times, and at least once required \nICU admission. Denies any history of withdrawal seizures. \nMaintained with CIWA scale until patient no longer scored on \nCIWA. Continued MVI, thiamine, folate. Patient part of 12 step \nprogram and says he will attend meeting tomorrow.\n\n# Abdominal pain: Likely multifactorial - in part related to \nforceful vomiting, alcoholic hepatitis leading to capsular \nstretch of both the liver and spleen, also may be a component of \ngastritis or exacerbation of GERD or ulcerative disease as he \nhas not taken his PPI reliably recently. In house resumed PPI \nand added ranitidine and GI cocktails for comfort.\n\n# Anion Gap Metabolic Acidosis: Likely from alcohol abuse. \nClosed over course of admission.\n\n# Alcoholic hepatitis & Portal hypertension, with evidence of \ncirrhosis on CT and prior US:: With regards to alcohol hepatitis \nit appears mild with ___ less than 5, so there is role for \nsteroids at this time. Patient has outpt liver follow up.\n\n# Narcotics dependence: Suboxone initially held during valium \ndosing for withdrawl but then restarted suboxone on day of \ndischarge (one dose of 8mg SL)\n\nINACTIVE ISSUES\n# Asthma: Intermittent inspiratory and expiratory wheezing, but \nno evidence of respiratory distress. Continued advair and \nalbuterol. \n\nTRANSITIONAL ISSUES\n# F/u appointment with ___ in hepatology on \n___ biopsy to characterize degree of fibrosis\n# Given one dose of 8mg tab suboxone on day of discharge\n# CONTACT: mother ___ ___', 'medications_prescribed': ['1. Cetirizine *NF* 10 mg Oral daily', '2. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID', '3. FoLIC Acid 1 mg PO DAILY', '4. Lactulose 30 mL PO DAILY', '5. Multivitamins 1 TAB PO DAILY', '6. Omeprazole 40 mg PO BID', '7. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath or \nwheezing', '8. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID', '9. Thiamine 100 mg PO DAILY', '10. Nadolol 10 mg PO DAILY']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 38, 'gender': 'F', 'symptoms': 'pericardial effusion', 'medical_history': ['Chronic a-fib s/p multiple CV + PVI', 'Childhood asthma', 'Melanoma on chest s/p excision (___)'], 'family_history': 'Father had atrial fibrillation, died of heart disease\nFamily concerned that mother also has arrhythmia', 'present_illness': '___ with hx symptomatic paroxysmal a-fib (___) on rivaroxaban\ns/p multiple cardioversions (___) on flecainide,\nPVI/CTI ablation (___), mild-mod MR ___ MVP, melanoma s/p\nresection (___) presented to ___ for repeat elective ablation\n(___), c/c/b enlarging pericardial effusion intra-operatively.\n\nFirst diagnosed with atrial fibrillation in ___ after episode \nof\nsymptomatic palpitations. Underwent multiple cardioversions, as\nwell as flecainide PRN without success. Ultimately, underwent\nelective PVI CTI ablation at ___ on ___. Of note, cardiac\nMRI from ___ demonstrated only trace physiologic\npericardial effusion. \n\nPrior to admission, he was in his usual state of health. No \nchest\npain, shortness of breath, edema, URI symptoms, or sick \ncontacts.\n\nOn ___, presented to ___ for repeat elective ablation PVI/CTI\nablation for chronic atrial fibrillation. Intra-operatively, he\nbecame hypotensive requiring phenylephrine. A TTE was obtained\nwhich showed new enlarging pericardial effusion.\nPericardiocentesis removed 950mL fluid (trace remaining after).\nPericardial drain placed. Received 600mL IVF back. Remained\nintubated after case. Admitted to CCU for hemodynamic monitoring\nand management of pericardial drain. Shortly after arrival to\nCCU, bedside TTE performed which showed minimal residual\npericardial effusion. Pericardial drain was subsequently pulled.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', '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': 'Expired', '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': 'Q6H: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': 'Acetaminophen', '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': 'Q6H: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': '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', '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': 'CefePIME', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', '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': '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': '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 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PATTERN-SPECKLED. 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': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'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': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 63.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'SMUDGE CELLS PRESENT.'}, {'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': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '___', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 429.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 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': '190', 'valuenum': 190.0, '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': '2.4', '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': '138', 'valuenum': 138.0, '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': '33', 'valuenum': 33.0, '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': '108', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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': '201', 'valuenum': 201.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '980', 'valuenum': 980.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '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': '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': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '___', 'valuenum': 66.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '32.5', 'valuenum': 32.5, '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': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '426', 'valuenum': 426.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': 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': '13', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, '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': '48', 'valuenum': 48.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.3', 'valuenum': 32.3, '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': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, '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': '18', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '458', 'valuenum': 458.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HIGH.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.9', 'valuenum': 3.9, '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '94', 'valuenum': 94.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, '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': '2+.'}, {'value': '46', 'valuenum': 46.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '425', 'valuenum': 425.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 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': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '429', 'valuenum': 429.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '32.6', 'valuenum': 32.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nGeneral: intubated\nHEENT: NC/AT\nLungs: ventilated breath sounds, intubated, CTAB\nHeart: RR, no M/R/G, 2+ radial pulses bilaterally, JVD not\nelevated\nChest: subxiphoid incision site C/D/I\nAbdomen: soft, non-distended, non-tender\nExtremities: \n - R femoral incision site C/D/I, no bruit\n - 2+ DP pulses bilaterally, extremities warm and dry\n - no edema, bruising, or bleeding\nSkin: (-) ulcers\nNeuro:\n - arousable to voice, answers questions by nodding head, obeys\nsimple commands\n - pupillary reflexes intact bilaterally\n - hand grip bilaterally, wiggles toes bilaterally\nPsych: intubated and sedated\n\nDISCHARGE PHYSICAL EXAM:\n========================\nGeneral: alert, no acute distress\nHEENT: NC/AT\nPulmonary: CTAB, no increased WOB\nCardiac: RRR, no M/R/G, 2+ radial pulses bilaterally, JVD not \nelevated\nChest: subxiphoid incision site C/D/I\nAbdomen: soft, non-distended, non-tender\nExtremities: \n - R femoral incision site C/D/I, no bruit\n - 2+ DP pulses bilaterally, extremities warm and dry\n - no edema, bruising, or bleeding\nSkin: (-) ulcers\nNeuro: AAOx3, CN intact, moving all extremities\nPsych: appropriate', 'diagnoses': [{'icd_code': '28804', 'desc': 'Neutropenia due to infection'}, {'icd_code': '4295', 'desc': 'Rupture of chordae tendineae'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}, {'icd_code': '7102', 'desc': 'Sicca syndrome'}, {'icd_code': '78061', 'desc': 'Fever presenting with conditions classified elsewhere'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '56942', 'desc': 'Anal or rectal pain'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '7804', 'desc': 'Dizziness and giddiness'}, {'icd_code': '7231', 'desc': 'Cervicalgia'}, {'icd_code': '6259', 'desc': 'Unspecified symptom associated with female genital organs'}, {'icd_code': '7856', 'desc': 'Enlargement of lymph nodes'}, {'icd_code': '37272', 'desc': 'Conjunctival hemorrhage'}, {'icd_code': '78079', 'desc': 'Other malaise and fatigue'}, {'icd_code': '7291', 'desc': 'Myalgia and myositis, unspecified'}, {'icd_code': 'V0481', 'desc': 'Need for prophylactic vaccination and inoculation against influenza'}, {'icd_code': 'V641'}, {'icd_code': '79571', 'desc': 'Nonspecific serologic evidence of human immunodeficiency virus [HIV]'}], 'summary': 'ADMISSION LABS:\n\n___ 05:23PM BLOOD Hgb-12.2* Hct-38.2*\n___ 05:49PM BLOOD ___ PTT-68.1* ___\n___ 08:17PM BLOOD Glucose-167* UreaN-18 Creat-0.9 Na-140 \nK-4.2 Cl-107 HCO3-21* AnGap-12\n___ 08:17PM BLOOD ALT-11 AST-18 LD(LDH)-153 AlkPhos-41 \nTotBili-0.6\n___ 08:17PM BLOOD Albumin-3.8 Calcium-8.4 Phos-3.8 Mg-1.7\n___ 03:04PM BLOOD ___ pO2-59* pCO2-40 pH-7.35 \ncalTCO2-23 Base XS--3\n\nDISCHARGE LABS:\n\n___ 04:01AM BLOOD WBC-9.4 RBC-3.87* Hgb-11.4* Hct-34.6* \nMCV-89 MCH-29.5 MCHC-32.9 RDW-12.9 RDWSD-42.2 Plt ___\n___ 04:01AM BLOOD Plt ___\n___ 04:01AM BLOOD Glucose-123* UreaN-16 Creat-0.8 Na-138 \nK-3.7 Cl-106 HCO3-23 AnGap-9*\nMr. ___ is a ___ year old male with history of symptomatic \nparoxysmal a-fib (___) on rivaroxaban refractory to multiple \ncardioversions (___), flecainide, PVI/CTI ablation \n(___), mitral valve prolapse, and melanoma after resection \n(___) who presented to ___ for repeat elective ablation \n(___), whose hospitalization as complicated by post-operative \npericardial effusion and pericarditis. \n\n====================\nACUTE/ACTIVE ISSUES:\n====================\n\n# Pericardial effusion and pericarditis\nOn ___, his elective ablation was complicated by a large \npericardial effusion. Pericardiocentesis removed 950mL fluid \nwith trace effusion remaining after, and a pericardial drain was \nplaced. Later that day (___), the drain was removed. ___ \necho (___) demonstrated small circumferential pericardial \neffusion without evidence of tamponade. Mr. ___ was \ndischarged on colchicine and aspirin and recommended for \n___ echo as an outpatient in ___ weeks. He should continue \ncolchicine and ibuprofen 600mg Q8H:PRN for symptom control, and \ntransition ibuprofen to aspirin 81mg when symptoms have improved \nto complete a one month course.\n\n# Atrial fibrillation\nOn ___, Mr. ___ underwent an elective PVI/CTI ablation. He \nwas discharged in sinus rhythm off his home flecainide. He \nshould continue rivaroxaban for anticoagulation and metoprolol \nsuccinate 25mg daily. ___ with Dr. ___ in one week.\n\n======================\nCHRONIC/STABLE ISSUES:\n======================\n\n# BPH\nContinued tamsulosin while inpatient.\n\n====================\nTRANSITIONAL ISSUES:\n====================\n\n- discharge hemoglobin 11.4\n\n[] PERICARDIAL EFFUSION: will need repeat echocardiogram in ___ \nweeks\n[] PERICARDITIS: continue colchicine and ibuprofen 600mg Q8H:PRN \nfor symptom control, and transition ibuprofen to aspirin 81mg \nwhen symptoms have improved to complete a one month course.\n\n=============='}}
|
{'final_diagnoses': ['Atrial fibrillation', 'Pericarditis', 'Pericardial effusion'], 'procedures': ['pulmonary vein and cavotricuspid isthmus ablation', 'pericardiocentesis', 'pericardial drain placement'], 'visit_summary': 'Mr. ___ is a ___ year old male with history of symptomatic \nparoxysmal a-fib (___) on rivaroxaban refractory to multiple \ncardioversions (___), flecainide, PVI/CTI ablation \n(___), mitral valve prolapse, and melanoma after resection \n(___) who presented to ___ for repeat elective ablation \n(___), whose hospitalization as complicated by post-operative \npericardial effusion and pericarditis. \n\n====================\nACUTE/ACTIVE ISSUES:\n====================\n\n# Pericardial effusion and pericarditis\nOn ___, his elective ablation was complicated by a large \npericardial effusion. Pericardiocentesis removed 950mL fluid \nwith trace effusion remaining after, and a pericardial drain was \nplaced. Later that day (___), the drain was removed. ___ \necho (___) demonstrated small circumferential pericardial \neffusion without evidence of tamponade. Mr. ___ was \ndischarged on colchicine and aspirin and recommended for \n___ echo as an outpatient in ___ weeks. He should continue \ncolchicine and ibuprofen 600mg Q8H:PRN for symptom control, and \ntransition ibuprofen to aspirin 81mg when symptoms have improved \nto complete a one month course.\n\n# Atrial fibrillation\nOn ___, Mr. ___ underwent an elective PVI/CTI ablation. He \nwas discharged in sinus rhythm off his home flecainide. He \nshould continue rivaroxaban for anticoagulation and metoprolol \nsuccinate 25mg daily. ___ with Dr. ___ in one week.\n\n======================\nCHRONIC/STABLE ISSUES:\n======================\n\n# BPH\nContinued tamsulosin while inpatient.\n\n====================\nTRANSITIONAL ISSUES:\n====================\n\n- discharge hemoglobin 11.4\n\n[] PERICARDIAL EFFUSION: will need repeat echocardiogram in ___ \nweeks\n[] PERICARDITIS: continue colchicine and ibuprofen 600mg Q8H:PRN \nfor symptom control, and transition ibuprofen to aspirin 81mg \nwhen symptoms have improved to complete a one month course.\n\n==============', 'medications_prescribed': ['Aspirin 81 mg PO DAILY \nDO NOT START until not using ibuprofen, complete one month of \ntherapy with aspirin 81mg daily \nRX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0', 'Colchicine 0.6 mg PO BID Duration: 14 Days \nRX *colchicine 0.6 mg 0.6 tablet(s) by mouth twice a day Disp \n#*28 Capsule Refills:*0', 'Ibuprofen 600 mg PO Q8H:PRN Pain - Mild \nFor symptom control \nRX *ibuprofen 600 mg 1 tablet(s) by mouth Q8H:PRN Disp #*30 \nTablet Refills:*0', 'Sucralfate 1 gm PO BID \nRX *sucralfate 1 gram 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0', 'Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day \nDisp #*30 Tablet Refills:*0', 'Rivaroxaban 20 mg PO QPM', 'saw ___ 1 tab oral DAILY', 'Tamsulosin 0.4 mg PO QHS']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 38, 'gender': 'F', 'symptoms': 'Planned Admission for stem cell mobilization.', 'medical_history': ['PAST ONCOLOGIC HISTORY: \n___: Patient was noted to have elevated calcium on routine labs. Further work up revealed monoclonal gammopathy. Patient \nwas closely monitored for his M protein.', '___: Patient was found to have elevated free light chains. Bone marrow biopsy revealed ___ marrow involvement with CD138 plasma cells. Cytogenetic analysis showed in addition to a chromosome 1 and chromosome 17 and FISH studies were abnormal with a gain of CKS1B on a long arm of chromosome 1 gain and part of chromosome 17 ___s loss of TP53 on chromosome 17 and a variant rearrangement involving IgH. Flow cytometry analysis showed a lambda restricted plasma cell neoplasm and low level involvement CD5, CD10, CD103 kappa restricted B cell population. Given elevated calcium and osteopenia (no lytic lesions), diagnosed with myeloma.', '___: Started on RVD, enrolled in ___ Protocol ___: BLOCKADE OF PD-1 IN CONJUNCTION WITH THE DENDRITIC CELL/MYELOMA VACCINES FOLLOWING STEM CELL TRANSPLANTATION.', 'OTHER PMH/PSH: \nMGUS and multiple myeloma as described above\nHTN since ___\nHemorrhoids ___\nBPH since ___\nBenign colon polyps in ___\nPolio as a child\nHypercholesterolemia since ___\nS/p tonsillectomy\nNephrolithiasis\nParathyroid adenoma'], 'family_history': 'He has a twin brother that is alive and well. \nOne sister who has a history of obesity. \nFather who died of "old age" at the age of ___. \nMother died at the age of ___, h/o congestive heart failure and cardiac disease.', 'present_illness': 'The patient is a ___ gentleman with a history of multiple myeloma initially \nsmoldering\ndisease dating back to ___ who is noted to have\nhypogammaglobulinemia, increased light chains up till ___ with\nbone marrow showing ___ involvement. The cytogenetic \nanalysis\nshowed a P53 mutation. This ultimately was thought to meet\ncriteria for moving forward with treatment and the patient was\nstarted on RVD which he began in ___. This was complicated\nby prolonged period of diarrhea with a protein losing\nenteropathy, ultimately found to have evidence of Yersenia, \nwhich\nwas thought to be the etiology. In this context, he had atrial\nfibrillation that was transient. The patient was then changed to\nCytoxan, Velcade and Decadron, which he received for three \ncycles\nand then received two cycles of RVD. He now presents for\nevaluation. The plan is to move forward for autologous\ntransplant and he will get stem cell mobilization on this \nadmission.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gralise', 'proc_type': 'Non-Formulary', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'QHS', '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': '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': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Loratadine', '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': 'QHS', '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': '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': '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': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID: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': 'Vitamin D', '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', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gralise', 'proc_type': 'Non-Formulary', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'QHS', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pseudoephedrine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Pseudoephedrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Capsaicin 0.025%', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.05', 'valuenum': 1.05, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, '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': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71.7', 'valuenum': 71.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.32', 'valuenum': 0.32, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.77', 'valuenum': 5.77, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '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': '30.1', 'valuenum': 30.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 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': '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': 3.3, 'ref_range_upper': 5.1, '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': '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '252', 'valuenum': 252.0, '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': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.8', 'valuenum': 49.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Effective ___, values will be reported from the ___ Vitamin D. Total assay. This assay accurately detects 25-hydroxyvitamin D3 but. does not accurately detect 25-hydroxyvitamin D2 and values may not be. accurate in patients taking vitamin D2 (ergocalciferol)..'}, {'value': '___', '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': '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': 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': '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': '___', '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '544', 'valuenum': 544.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': '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': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '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': '85', 'valuenum': 85.0, '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': 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': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.5', 'valuenum': 49.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', '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': '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': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '84', 'valuenum': 84.0, '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': 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': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '48.6', 'valuenum': 48.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '233', 'valuenum': 233.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.16', 'valuenum': 4.16, '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': '50.5', 'valuenum': 50.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '18', 'valuenum': 18.0, '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': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 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': '4.19', 'valuenum': 4.19, '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': '49.8', 'valuenum': 49.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen: Pleasant, calm\nHEENT: No conjunctival pallor. No icterus. MMM. OP clear.\nNECK: Normal carotid upstroke without bruits.\nLYMPH: No cervical or supraclav LAD\nCV: Normocardic, regular. Normal S1,S2. No MRG.\nLUNGS: No incr WOB. CTAB. No wheezes, rales, or rhonchi.\nABD: NABS. Soft, NT, ND.\nEXT: WWP. No ___ edema.\nSKIN: No rashes/lesions, petechiae/purpura ecchymoses.\nNEURO: A&Ox3.', 'diagnoses': [{'icd_code': 'M5116', 'desc': 'Intervertebral disc disorders with radiculopathy, lumbar region'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'J309', 'desc': 'Allergic rhinitis, unspecified'}, {'icd_code': 'Z6833', 'desc': 'Body mass index [BMI] 33.0-33.9, adult'}, {'icd_code': 'K5903', 'desc': 'Drug induced constipation'}, {'icd_code': 'T3995XA', 'desc': 'Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}], 'summary': 'Admission:\n\n___ 09:10PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 09:10PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n___ 09:10PM URINE RBC-0 WBC-1 BACTERIA-NONE YEAST-NONE \nEPI-0\n___ 09:10PM URINE MUCOUS-RARE\n___ 11:40AM UREA N-16 CREAT-0.8 SODIUM-140 POTASSIUM-4.8 \nCHLORIDE-104 TOTAL CO2-30 ANION GAP-11\n___ 11:40AM estGFR-Using this\n___ 11:40AM ALT(SGPT)-18 AST(SGOT)-20 LD(LDH)-139 ALK \nPHOS-57 TOT BILI-0.8 DIR BILI-0.2 INDIR BIL-0.6\n___ 11:40AM TOT PROT-5.8* ALBUMIN-4.5 GLOBULIN-1.3* \nCALCIUM-10.3 PHOSPHATE-3.8 MAGNESIUM-1.9 URIC ACID-5.5\n___ 11:40AM WBC-3.6* RBC-4.07* HGB-14.9 HCT-42.4 MCV-104* \nMCH-36.6* MCHC-35.1* RDW-14.0\n___ 11:40AM NEUTS-57.0 ___ MONOS-7.8 EOS-4.6* \nBASOS-0.9\n___ 11:40AM PLT COUNT-175\n\nDischarge:\n\n___ 08:20AM BLOOD WBC-4.7 RBC-4.28* Hgb-15.4 Hct-43.8 \nMCV-102* MCH-36.1* MCHC-35.2* RDW-13.8 Plt ___\n___ 08:20AM BLOOD Glucose-155* UreaN-15 Creat-0.7 Na-139 \nK-4.3 Cl-107 HCO3-23 AnGap-13\n___ 08:20AM BLOOD Calcium-8.8 Phos-2.5* Mg-1.___\nSSESSMENT/PLAN: This is a ___ w/ h/o multiple myeloma s/p \ninduction RVD, BPH, who presents for Cyclophosphamide-Stem Cell \nMobilization.\n\n# MM Treatment Plan: High dose cyclophosphamide for Stem Cell \nMobilization in prep for Auto SCT. He received fluids at \n150cc/hr and UAs Q8H to check for Hemorrhagic cystitis. His UOP \nwas only 75cc after being positive 1.5L and thus he was given 20 \nIV lasix with good output and above our goal of 100cc/hr. Per \nplan, he will get Neupogen and then stem cell collection. \nBaseline UA negative for blood and subsequent UAs also negative.\n\n\n# ID PPX: continued on Acyclovir and Bactrim.\n\n# BPH: continued on tamsulosin ER. symptoms stable.\n\n# A fib - Rate controlled on metop. CHADS2 score of 2 on \nXarelto; however, it was stopped 4 days ago by his Cardiologist \nwho no longer feels it is necessary (his a.fib was in the \nsetting of colitis and dehydration with no episodes since).'}}
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{'final_diagnoses': ['Multiple Myeloma.'], 'procedures': ['None'], 'visit_summary': 'SSESSMENT/PLAN: This is a ___ w/ h/o multiple myeloma s/p \ninduction RVD, BPH, who presents for Cyclophosphamide-Stem Cell \nMobilization.\n\n# MM Treatment Plan: High dose cyclophosphamide for Stem Cell \nMobilization in prep for Auto SCT. He received fluids at \n150cc/hr and UAs Q8H to check for Hemorrhagic cystitis. His UOP \nwas only 75cc after being positive 1.5L and thus he was given 20 \nIV lasix with good output and above our goal of 100cc/hr. Per \nplan, he will get Neupogen and then stem cell collection. \nBaseline UA negative for blood and subsequent UAs also negative.\n\n\n# ID PPX: continued on Acyclovir and Bactrim.\n\n# BPH: continued on tamsulosin ER. symptoms stable.\n\n# A fib - Rate controlled on metop. CHADS2 score of 2 on \nXarelto; however, it was stopped 4 days ago by his Cardiologist \nwho no longer feels it is necessary (his a.fib was in the \nsetting of colitis and dehydration with no episodes since).', 'medications_prescribed': ['1. Acyclovir 400 mg PO Q8H', '2. Metoprolol Succinate XL 50 mg PO DAILY', '3. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain', '4. Sulfameth/Trimethoprim SS 1 TAB PO DAILY', '5. Tamsulosin 0.4 mg PO QHS', '6. Vitamin D 2500 UNIT PO DAILY', 'Pt was already given perscription for Ciprofloxacin and Neupogen']}
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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': 'hand numbness', 'medical_history': ['CVA with right distal weakness', 'diet controlled diabetes', 'pilonidal cyst excision'], 'family_history': 'noncontributory', 'present_illness': '___ followed in clinic for cervical myelopathy who has been \nmanaged expectantly. Slight progression in symptoms and \npresents for elective posterior cervical decompression and \nfusion.', 'medications': [{'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'TraMADOL (Ultram)', '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/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID: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': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': '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': [], 'exams': 'A and O x 3\nHt RRR Nl S1,S2\nLungs CTA\nabd: obese, soft\nNeuro: Motor: grip bilat ___\nR ___ 4+/5\notherwise ___\n\nexam upon discharge:\nright deltoid 4=/5, bilat grips ___\nR ___ 4=/5\nall else ___', 'diagnoses': [{'icd_code': '2330', 'desc': 'Carcinoma in situ of breast'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': '___ 06:57PM WBC-9.7 RBC-3.98* HGB-11.8* HCT-34.5* MCV-87 \nMCH-29.7 MCHC-34.3 RDW-13.9\n___ 06:57PM PLT COUNT-192\n___ 06:57PM ___ PTT-28.6 ___\n\nCXR ___: Low lung volumes. Retrocardiac opacity could be \natalectasis; however pneumonia cannot be excluded. Opacity at \nthe right upper lung lateral to the trachea could suggest \nsuperinfection. Apperance of elevation of the right \nhemi-diaphragm, could be due to pleural effusion. \n\nCXR ___ of the right hemidiaphragm is not as \npronounced. Atelectasis persists at the right lung base. Left \nlung clear. Heart size is normal. There is no right pneumothorax \nbut there may be a small dependent right pleural effusion.Heart \nsize is normal. Left lung is clear and there is no left pleural \nabnormality. \n\nCXR ___ 12:19 ___: No change in right pleural effusion \nwith subpulmonic component. \nPt was admitted electively to the hospital and went to the OR \nwhere under general anesthesia he underwent posterior cervical \ndecompression and instrumented fusion C2-7 under general \nanesthesia. He tolerated this procedure well and was \ntransferred to PACU. Due to length of prone position pt had \nfacial edema requiring intubation overnight. On the first post \nop morning he was extubated without incident. He had JP drain \nplaced intraop that was monitored. His neuro exam post op was \nstable with pre-op. His dressing was dry. He was transitioned \nto po meds. His diet was advanced. He had some difficulty with \noxygen saturations and CXR reevealed pleural effusion. He was \nstarted on lasix and he diuresed and O2 saturation levels and \nCXR both improved. His incision was clean and dry with staples \nintact. His foley was removed but required replacement for \nretention. He was started on flomax. Voiding trial was tried \nagain ___ and though he was initially able to urinate several \nhours later he had distention with over a liter in his bladder \nand he had foley replaced. He had leg bag training. ___ \nevalutated him and determined he would be appropriate for home \n___. Home services were arranged and PCP was contacted and plan \nfor follow up care coordinated.'}}
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{'final_diagnoses': ['cervical stenosis', 'urinary retention', 'pleural effusion'], 'procedures': ['posterior cervical instrumented fusion'], 'visit_summary': 'Pt was admitted electively to the hospital and went to the OR \nwhere under general anesthesia he underwent posterior cervical \ndecompression and instrumented fusion C2-7 under general \nanesthesia. He tolerated this procedure well and was \ntransferred to PACU. Due to length of prone position pt had \nfacial edema requiring intubation overnight. On the first post \nop morning he was extubated without incident. He had JP drain \nplaced intraop that was monitored. His neuro exam post op was \nstable with pre-op. His dressing was dry. He was transitioned \nto po meds. His diet was advanced. He had some difficulty with \noxygen saturations and CXR reevealed pleural effusion. He was \nstarted on lasix and he diuresed and O2 saturation levels and \nCXR both improved. His incision was clean and dry with staples \nintact. His foley was removed but required replacement for \nretention. He was started on flomax. Voiding trial was tried \nagain ___ and though he was initially able to urinate several \nhours later he had distention with over a liter in his bladder \nand he had foley replaced. He had leg bag training. ___ \nevalutated him and determined he would be appropriate for home \n___. Home services were arranged and PCP was contacted and plan \nfor follow up care coordinated.', 'medications_prescribed': ['1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*0*', '2. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily). ', '3. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times \na day). ', '4. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '6. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times \na day). ', '7. Pregabalin 75 mg Capsule Sig: Two (2) Capsule PO TID (3 times \na day). ', '8. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic BID (2 \ntimes a day). ', '9. Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain.\nDisp:*50 Tablet(s)* Refills:*0*', '10. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime).\nDisp:*30 Capsule, Sust. Release 24 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': 50, 'gender': 'F', 'symptoms': 'Urinary Tract Infection', 'medical_history': ['1. History of nephrolithiasis ', '- status post laser lithotripsy and stent to left ureter in ___. ', '- s/p ureteral stent replacement in ___. Hypertension ', '3. Morbid obesity ', '4. History of pyelonephritis ', '5. History of E.coli, enterobacter bacteremia ', '6. Sickle cell trait'], 'family_history': 'Mother - ___\nFather - ___ Heart Failure', 'present_illness': 'Time of Initial Evaluation: 11:45pm on ___ \n\n___ female with history of nephrolithiasis s/p ureteral stent \nplacement, hypertension, and recurrent urinary tract infections \nwas admitted from the ED with likely urinary tract infection.\n\nOf note, she was recently admitted from ___ with a \nurinary tract infection, complicated by nephrolithiasis and \nurinary tract obstruction. She had her ureteral stent replaced \nwith urology. Since discharge, she has missed a follow-up \nappointment to arrange stent removal. She has been feeling \nrelatively well. She then developed 3 days of suprapubic pain \nand subjective fevers and chills. She presented to an OSH ED \nyesterday with these symptoms at which time she was diagnosed \nwith a urinary tract infection and was discharged with \nciprofloxacin. She did not fill this prescription due to cost. \nSince yesterday, she has been unable to tolerate oral intake and \nthen presented to the ED. \n\nUpon arrival in the ED, temp 96.6, HR 105, BP 153/95, RR 12, and \npulse ox 99% on room air. Exam was notable for suprapubic \ntenderness to palpation. Labs are notable for Hct 29.7, Cr 1.2, \nand UA with > 50 WBCs, mod bacteria, ___ epis, and positive \nnitrates. She received 1L IVF, vicodin 1 tab x 1, ciprofloxacin \n250mg PO x 1, and zofran 2mg IV x 1. While in the ED, she \ndeveloped episodic shortness of breath which has now improved. \nCXR at the time was unremarkable. \n\nShortly after arrival to the floor, she was hypertensive to \n200s/100s with nausea, vomiting, and chest pain. Her chest pain \nimproved almost immediately after vomiting and also after having \ntaken SL NG x 1.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', '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': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Prochlorperazine', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, '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': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '43.1', 'valuenum': 43.1, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, '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 1.7, . Estimated GFR = 32 if non African-American (mL/min/1.73 m2) . Estimated GFR = 38 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', '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': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.31', 'valuenum': 3.31, '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': '42.1', 'valuenum': 42.1, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', 'valuenum': 2.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': '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': '11', 'valuenum': 11.0, '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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, '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': 'RARE.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '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': '127', 'valuenum': 127.0, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, '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': '15', 'valuenum': 15.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.4', 'valuenum': 1.4, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 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': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '243', 'valuenum': 243.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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}, {'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': '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': 0.4, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T 99.4 / BP 162/94 / HR 72 / RR 22 / Pulse ox 99% on room air\nGen: no acute distress, resting comfortably in bed, speaking \nclearly, very pleasant\nHEENT: Clear OP, MMM\nNECK: Supple, No LAD, No JVD\nCV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops\nLUNGS: CTA, BS ___, No W/R/C\nABD: + BS, tender to soft palpation throughout abdomen but most \nprominent in suprapubic area, no rebound or guarding\nBACK: no CVA tenderness\nEXT: No edema. 2+ DP pulses ___\nSKIN: No lesions\nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. ___ strength \nthroughout. Normal coordination. Gait assessment deferred\nPSYCH: Listens and responds to questions appropriately, pleasant', 'diagnoses': [{'icd_code': 'N201', 'desc': 'Calculus of ureter'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}], 'summary': '___ \nNa 139 / K 3.6 / Cl 105 / CO2 22 / BUN 9 / Cr 1.2 \nWBC 6 / Hct 29.7 / Plt 466\nN 74 / L 19 / M 6 / E 1 / B 0 \nUA - yellow, cloudy, 1.020, pH 7.5, urobili 1, large leuks, \nlarge blood, pos nitr, > 300 prot, neg gluc, ___ epis\n\nBaseline Cr .___\nBaseline Hct ___\n___ year old woman with a history of recurrent multi-drug \nresistant urinary tract infections who was admitted to the \nhospital with a possible urinary tract infection as her UA was \nconcerning for infection, although it had large amounts of \nepithelial cells. She had a history of UTIs (proteus) resistant \nto fluoroquinolones and all cephalosporins (including ___ and \n___ generation) in the past. She had 2 urine cultures. The first \nwas negative and the second was pending at the time of discharge \n( initial: Alpha hemolytic colonies consistent with alpha \nstreptococcus or\nLactobacillus sp). She was treated empirically with Bactrim \nbecause of history of proteus. The patient is known to have \nbilateral staghorn nephrolithiasis requiring left ureteral stent \nplacement. She was supposed to have ureteral stent removed, but \nshe has missed her appointment. We contacted urology who \nrescheduled her for an earlier appointment for stent removal ( \nnot good to manipulate a stent with possible infection). She had \na renal U/S without change in her hydronephrosis. During this \nhospitalization, she was noted to have severe and progressive \nanemia that goes back for at least last ___ years. She has Sickle \ncell trait which does NOT cause anemia. Iron studies revealed \nsignificant deficiency which was consistent with her prior \ntests. She stopped taking her Iron supplements, and had no \nexternal bleeding except for regular periods. She had one \ncolonoscopy long time ago. She was asymptomatic except for \nsignificant tachycardia on ambulation ( HR 135; resting HR of \n85). She denied SOB or palpitations. She had no history of \ncardiac disease but long standing anemia is associated with \ncardiomyopathy. The patient was never seen by a hematologist. \nHer kidney function was borderline and may or may not explain \nanemia of chronic disease. She had unremarkable echocardiogram \nand lung scans. These were done to exclude structural heart \nproblems or PE to explain the exertional tachycardia (other than \nanemia). She received one dose of IV Ferrlecit in the hospital \nand oral iron sulfate. I contacted the covering PCP regarding \nher anemia and exertional sinus tachycardia as the patient \nrequested discharge and I was unable to do detailed work up \nexcept for the above. total discharge time 45 minutes. '}}
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{'final_diagnoses': ['Possible UTI', 'Severe anemia', 'Tachycardia with ambulation'], 'procedures': ['None'], 'visit_summary': '___ year old woman with a history of recurrent multi-drug \nresistant urinary tract infections who was admitted to the \nhospital with a possible urinary tract infection as her UA was \nconcerning for infection, although it had large amounts of \nepithelial cells. She had a history of UTIs (proteus) resistant \nto fluoroquinolones and all cephalosporins (including ___ and \n___ generation) in the past. She had 2 urine cultures. The first \nwas negative and the second was pending at the time of discharge \n( initial: Alpha hemolytic colonies consistent with alpha \nstreptococcus or\nLactobacillus sp). She was treated empirically with Bactrim \nbecause of history of proteus. The patient is known to have \nbilateral staghorn nephrolithiasis requiring left ureteral stent \nplacement. She was supposed to have ureteral stent removed, but \nshe has missed her appointment. We contacted urology who \nrescheduled her for an earlier appointment for stent removal ( \nnot good to manipulate a stent with possible infection). She had \na renal U/S without change in her hydronephrosis. During this \nhospitalization, she was noted to have severe and progressive \nanemia that goes back for at least last ___ years. She has Sickle \ncell trait which does NOT cause anemia. Iron studies revealed \nsignificant deficiency which was consistent with her prior \ntests. She stopped taking her Iron supplements, and had no \nexternal bleeding except for regular periods. She had one \ncolonoscopy long time ago. She was asymptomatic except for \nsignificant tachycardia on ambulation ( HR 135; resting HR of \n85). She denied SOB or palpitations. She had no history of \ncardiac disease but long standing anemia is associated with \ncardiomyopathy. The patient was never seen by a hematologist. \nHer kidney function was borderline and may or may not explain \nanemia of chronic disease. She had unremarkable echocardiogram \nand lung scans. These were done to exclude structural heart \nproblems or PE to explain the exertional tachycardia (other than \nanemia). She received one dose of IV Ferrlecit in the hospital \nand oral iron sulfate. I contacted the covering PCP regarding \nher anemia and exertional sinus tachycardia as the patient \nrequested discharge and I was unable to do detailed work up \nexcept for the above. total discharge time 45 minutes. ', 'medications_prescribed': ['1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation. ', '2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '4. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) \nTablet PO BID (2 times a day) for 4 days.\nDisp:*8 Tablet(s)* Refills:*0*', '5. Enalapril Maleate 10 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily). ', '6. Hydrocodone-Acetaminophen ___ mg Tablet Sig: One (1) Tablet \nPO Q6H (every 6 hours) as needed for pain for 3 days.\nDisp:*10 Tablet(s)* Refills:*0*', '7. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One \n(1) Tablet PO twice a day for 4 weeks.\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': 51, 'gender': 'F', 'symptoms': 'Abdominal pain, diarrhea, hematemesis', 'medical_history': ['CAD s/p PCI (___)- per patient stented LAD. Stopped Plavix "A \nfew years ago)', 'Insulin-dependent diabetes mellitus', 'Irregular heart rhythm with atrial ectopy', 'Non-Hodgkins Lymphoma - s/p 6 cycles of Rituxan at ___ (about \n___ ago)', 'Hypothyroidism', 'Hyperlipidemia', 'Obesity', 's/p appendectomy', 's/p tonsillectomy', '___ - hospitalized for eval of CHF and NSTEMI s/p PCI', 'ONC HISTORY:', '___ Enlarged lymph node L neck (over previous 6 months to size \n\nof grape)', '___ Lymph node biopsy of Left posterior cervical LN c/w \nGrade ___ follicular lymphoma', '___ CT chest/abd/pelvis w stable dsiease w no evidence of \ndisease progression', '___ CT ch/ab/pelvis- no change', '___ CT scans ___ lymph nodes, no change', '___ No evidence of lymphoma w/in the abdomen'], 'family_history': 'Aunt: ___ cancer in her ___. Mom: ?questionable afib, CAD. \nFather deceased at ___ from possible MI', 'present_illness': '___ year old male with T2DM, h/o NHL, CAD and recent admission \nwith abdominal pain who presents with abdominal pain, diarrhea, \nand hematemesis. \n. \nHe was recently admitted ___ to ___ with abdominal \npain and nausea. At that time he was found to have a chronic \nSpigelian hernia as well as inguinal and para-aortic \nlymphadenopathy concerning for recurrent NHL. He was seen by \nheme/onc who recommended outpatient follow-up at ___ (where his \noncologist is) but he has not yet gone to that appointment. The \nsurgical team felt that his hernia was unlikely to be causing \nhis symptoms. He was thought to possibly have a viral \ngastroenteritis. He cannot state what his diagnosis was or what \nhe was told at his last hospitalization. \n. \nHe was discharged to rehab 5 days ago. Today he developed severe \ndry heaves and worsening abdominal pain. He describes the pain \nas constant and severe, located in the suprapubic area and \nradiating around to his back. He then developed multiple \nepisodes of vomiting, including one episode of vomiting bright \nred blood ("2 mouthfuls."). He also describes ___ days of \nnonbloody diarrhea, but said that the nurse at his rehab thought \nthere may be blood in his stool. He has had ___ episodes of \ndiarrhea per day. \n. \nIn the ED, initial VS were: 98.6 70 120/66 16 98%. Labs notable \nfor Hct of 30.7, which is his recent baseline, normal coags, \nwith elevated creatinine to 1.6 from his baseline of 1.0. Repeat \nCT abd/pelvis for abdominal pain was unchanged with \nlymphadenopathy and a hernia. Given 1L IVF. NG tube placed with \nnegative lavage. Guaiac positive with liquid brown stool. He was \ngiven a dose of zofran. Vitals on transfer were 119/62 77 22 \n94%RA 98.6. \n. \nOn the floor, he reports no abdominal pain and no more dry \nheaves. \n.', 'medications': [{'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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92.9', 'valuenum': 92.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: 96.2 127/57 89 20 97%RA 296.4lbs \nGeneral: Arousable but sleepy appearing, oriented x3 but \ninattentive and loses track of thoughts when answering \nquestions, no acute distress \nHEENT: Sclera anicteric, MM slightly dry, oropharynx clear \nNeck: Supple but obese, JVP not able to assess, no palpable \nlymphadenopathy \nLungs: Significant upper airway noise with mild rhonchi at the \nbases that clears with cough, no wheezes or rales \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft and very obese, only mildly tender to palpation \nover suprapubic area and LLQ, no CVA tenderness, no organomegaly \npalpable, no rebound or guarding \nExt: Warm, well perfused with 1+ peripheral edema, no clubbing, \ncyanosis', 'diagnoses': [{'icd_code': '0380', 'desc': 'Streptococcal septicemia'}, {'icd_code': '475', 'desc': 'Peritonsillar abscess'}, {'icd_code': '0340', 'desc': 'Streptococcal sore throat'}, {'icd_code': '99591', 'desc': 'Sepsis'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': "ADMISSION LABS:\n.\n___ 06:45PM BLOOD WBC-10.6 RBC-3.34* Hgb-10.2* Hct-30.7* \nMCV-92 MCH-30.5 MCHC-33.2 RDW-14.5 Plt ___\n___ 06:45PM BLOOD Neuts-79.4* Lymphs-13.8* Monos-5.4 \nEos-1.2 Baso-0.2\n___ 06:45PM BLOOD ___ PTT-21.2* ___\n___ 06:45PM BLOOD Glucose-115* UreaN-40* Creat-1.6* Na-137 \nK-4.1 Cl-98 HCO3-26 AnGap-17\n___ 06:45PM BLOOD ALT-39 AST-36 LD(LDH)-368* AlkPhos-73 \nTotBili-0.3\n___ 07:15AM BLOOD Calcium-8.0* Phos-4.1 Mg-2.1\n___ 06:45PM BLOOD VitB12-471\n___ 06:45PM BLOOD TSH-2.9\n.\nDISCHARGE LABS:\n.\n___ 07:00AM BLOOD WBC-7.9 RBC-3.33* Hgb-10.2* Hct-30.7* \nMCV-92 MCH-30.8 MCHC-33.4 RDW-14.5 Plt ___\n___ 07:00AM BLOOD Glucose-182* UreaN-14 Creat-1.0 Na-138 \nK-4.1 Cl-100 HCO3-29 AnGap-13\n___ 07:00AM BLOOD Calcium-8.9 Phos-2.9 Mg-1.8\n.\nCT ABDOMEN/PELVIS ___:\n1. Sigmoid diverticulosis, but no diverticulitis. Evaluation for \nmesenteric ischemia is not possible on this \nnon-contrast-enhanced scan. \n2. Extensive abdominal, pelvic, and inguinal lymphadenopathy, \nsimilar to the prior examination, concerning for lymphoma. \n3. Left-sided IVC. \n4. Atherosclerotic disease and coronary vascular disease. \n5. Right Spigelian hernia containing non-obstructed and \nnon-dilated loops of bowel.\n___ year old male with h/o CAD, IDDM, possible CHF, \nhypothyroidism and h/o NHL who presents with dry heaves, \nabdominal pain, diarrhea, and hematemesis. \n. \n#. Hematemesis: Patient gave unclear history on admission, \nstating that he looked in the toilet and saw frank blood, but \ncould not recall if it was from his stool or vomiting. In the \nED, patient's stool was brown, but guiac positive. Patient's \nadmission Hct was 26, 4 lower than discharge hematocrit from one \nweek prior; however, there were no signs of any active bleed. \nHe received no transfusions, and was briefly on IV ppi. Hct on \ndischarge was 30. Patient had an endoscopy on ___ that was \nnegative. Flexible signmoidoscopy showed no active bleeding. \nFound to have colonic diverticulae, and localized erythema and \ncongestion with no bleeding were noted in the sigmoid colon, of \nwhich a biopsy was taken. Patient continued to be \nhemodynamically stable and will be discharged on BID PO PPI with \nclose PCP follow up.\n. \n#. Diarrhea/Nausea: Has had ___ days of new onset diarrhea, \nwhich he has not complained of before. By discharge, patient \nwas having formed stools. All stool cultures pending by time of \ndischarge. He was able to tolerate foods without nausea or \ndry-heaving.\n. \n#. Paraortic and inguinal lymphadenopathy: CT scan showing \nstable lymphadenopathy. Plan is to get a lymph node biopsy as \nan outpatient. Close follow up in place with patient's primary \noncologist, Dr. ___ at ___. \n. \n#. Acute kidney injury: Creatinine 1.6 from baseline of 1.0 on \nadmission. Most likely etiology prerenal in the setting of \ndiarrhea and vomiting. Patient's creatinine improved to .8 on \ndischarge with IVF hydration. \n. \n#. CAD: Has reported history of stent placement, currently \ndenies chest pain or SOB. Will discharge on home statin, ASA, \nbeta blocker.\n. \n#. Irregular cardiac rhythm: Has known chronic irregular heart \nrhythm, ECG is sinus with frequent PACs and PVCs. Had multiple \nepisodes of ectopy on telemetry at last hospitalization. \nRemains asymptomatic and was monitored on telemetry, which again \nshowed multiple episodes of asymptomatic ectopy.\n. \n#. History of CHF: Is on Lasix, bumetanide, and hyzaar per prior \nadmission. OSH showed EF 55% as of ___ with mild symmetric LVH. \n Presumably was on diuretics for lower extremity edema, possibly \nrelated to lymphadenopathy. His diuretics were initially held \non admission due to possibility of acute bleed. However, his \nhemodynamics remained stable and he was restarted on the \ndiuretics prior to discharge. \n. \n#. IDDM: Poorly controlled BS with HbA1C 7.8% on last admission. \n He was conitnued on home glargine 45units at night plus ISS \nstarting at 10 units with meals \n. \n#. Hypothyroidism: Continued levothyroxine"}}
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{'final_diagnoses': ['Primary: Diarrhea', 'Secondary: Lymphoma', 'Diabetes Mellitus Type 2', 'Hyperlipidemia', 'Hypothyroid'], 'procedures': ['EGD/fexible sigmoidoscopy'], 'visit_summary': "___ year old male with h/o CAD, IDDM, possible CHF, \nhypothyroidism and h/o NHL who presents with dry heaves, \nabdominal pain, diarrhea, and hematemesis. \n. \n#. Hematemesis: Patient gave unclear history on admission, \nstating that he looked in the toilet and saw frank blood, but \ncould not recall if it was from his stool or vomiting. In the \nED, patient's stool was brown, but guiac positive. Patient's \nadmission Hct was 26, 4 lower than discharge hematocrit from one \nweek prior; however, there were no signs of any active bleed. \nHe received no transfusions, and was briefly on IV ppi. Hct on \ndischarge was 30. Patient had an endoscopy on ___ that was \nnegative. Flexible signmoidoscopy showed no active bleeding. \nFound to have colonic diverticulae, and localized erythema and \ncongestion with no bleeding were noted in the sigmoid colon, of \nwhich a biopsy was taken. Patient continued to be \nhemodynamically stable and will be discharged on BID PO PPI with \nclose PCP follow up.\n. \n#. Diarrhea/Nausea: Has had ___ days of new onset diarrhea, \nwhich he has not complained of before. By discharge, patient \nwas having formed stools. All stool cultures pending by time of \ndischarge. He was able to tolerate foods without nausea or \ndry-heaving.\n. \n#. Paraortic and inguinal lymphadenopathy: CT scan showing \nstable lymphadenopathy. Plan is to get a lymph node biopsy as \nan outpatient. Close follow up in place with patient's primary \noncologist, Dr. ___ at ___. \n. \n#. Acute kidney injury: Creatinine 1.6 from baseline of 1.0 on \nadmission. Most likely etiology prerenal in the setting of \ndiarrhea and vomiting. Patient's creatinine improved to .8 on \ndischarge with IVF hydration. \n. \n#. CAD: Has reported history of stent placement, currently \ndenies chest pain or SOB. Will discharge on home statin, ASA, \nbeta blocker.\n. \n#. Irregular cardiac rhythm: Has known chronic irregular heart \nrhythm, ECG is sinus with frequent PACs and PVCs. Had multiple \nepisodes of ectopy on telemetry at last hospitalization. \nRemains asymptomatic and was monitored on telemetry, which again \nshowed multiple episodes of asymptomatic ectopy.\n. \n#. History of CHF: Is on Lasix, bumetanide, and hyzaar per prior \nadmission. OSH showed EF 55% as of ___ with mild symmetric LVH. \n Presumably was on diuretics for lower extremity edema, possibly \nrelated to lymphadenopathy. His diuretics were initially held \non admission due to possibility of acute bleed. However, his \nhemodynamics remained stable and he was restarted on the \ndiuretics prior to discharge. \n. \n#. IDDM: Poorly controlled BS with HbA1C 7.8% on last admission. \n He was conitnued on home glargine 45units at night plus ISS \nstarting at 10 units with meals \n. \n#. Hypothyroidism: Continued levothyroxine", 'medications_prescribed': ['1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO PRN (as needed) as needed for constipation.', '4. bisacodyl 5 mg Tablet Sig: Two (2) Tablet PO once a day as \nneeded for constipation.', '5. bumetanide 1 mg Tablet Sig: One (1) Tablet PO once a day: Can \nincrease to 2 mg/day for severe lower extremity swelling.', '6. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO twice \na day.', '7. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '8. bethanechol chloride 25 mg Tablet Sig: One (1) Tablet PO \ntwice a day.', '9. Hyzaar 100-25 mg Tablet Sig: One (1) Tablet PO once a day.', '10. fluoxetine 40 mg Capsule Sig: One (1) Capsule PO at bedtime.', '11. Humalog 100 unit/mL Cartridge Sig: per sliding scale \nSubcutaneous After meals.', '12. Lantus 100 unit/mL Solution Sig: One (1) cartridge \nSubcutaneous once a day: 45 untis at bedtime.', '13. Robitussin Chest Congestion 100 mg/5 mL Liquid Sig: Twenty \n(20) mL PO three times a day as needed for cough.', '14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H \n(every 6 hours) as needed for pain, fever.', '15. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO twice a day.', '16. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '17. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', '18. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID \n(2 times a day) as needed for constipation.', '19. aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.', '20. ondansetron HCl (PF) 4 mg/2 mL Solution Sig: One (1) \nInjection Q8H (every 8 hours) as needed for nausea.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 43, 'gender': 'F', 'symptoms': 'Jaundice', 'medical_history': ['Fibromyalgia', 'Anxiety', 'Depression', 'Muscle Spasms'], 'family_history': 'M (living) with psychiatric illness \nF (living) is healthy \nNo known family history of autoimmune disease, ___ disease, \nor hemachromatosis', 'present_illness': 'Ms. ___ is a ___ with history of fibromyalgia and low back \npain who complains of feeling unwell, developing yellow eyes, \nand vomiting that started two weeks ago. The patient reports it \nhas become worse in the last 5 days. She has minimal abdominal \npain but is tender. She denies history of alcohol use, IVDU, \nrecreational drug use, gallstone disease, and emphatically \ndenies acetaminophen use. Of note, patient took naproxen about \none month ago in setting of past allergic reaction to NSAIDs, \nand experienced resulting tongue swelling and "lock jaw". She \ndid not pursue evaluation at the time, but believes her current \nsymptoms started after this episode. Patient reports past \nimmunization to hepatitis. \n\nIn the ED, initial vitals were 98.6 113 115/85 16 98%RA. Initial \nlabs demonstrated HCT 48.2%, unremarkable chem-7, ALT 705, AST \n779 AP 191, TB 9.2, DB 7.3, albumin 3.8, and INR 1.0. Serum \nacetaminophen and etOH were negative. A RUQ U/S demonstrated \nechogenic portal triads consistent with hepatitis, without \nintra- or extrahepatic biliary duct dilation, CBD 3mm. The \npatient was admitted for further evaluation. \n\nUpon arrival to the floor, initial vital signs were 98 115/72 89 \n16 98RA. She is accmompanied by a friend who is acquainted with \nDr. ___.', 'medications': [{'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'rilpivirine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'ONCE', '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': 'Benzonatate', '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': 'Emtricitabine-Tenofovir (Truvada)', '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': 'Discontinued', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': 'Naproxen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'rilpivirine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Systane', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID: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': 'Colchicine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '___', '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': 'GREATER THAN 1:1280. 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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '355', 'valuenum': 355.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.4, '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': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '460', 'valuenum': 460.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', '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': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '384', 'valuenum': 384.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, '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}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 90.0, 'ref_range_upper': 180.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', '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': '4.2', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '394', 'valuenum': 394.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/mg', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Exam\nVS: 98 115/72 89 16 98RA \nGeneral: well-appearing female, upright in bed, smells of \ntobacco smoke \nHEENT: NCAT, MMM, faint scleral icterus \nNeck: Supple, no LAD \nCV: RRR (+)S1/S2 no m/r/g \nLungs: Generally CTA b/l, scattered faint wheeze \nAbdomen: Soft, mild diffuse tenderness worse in the RUQ, \nnon-distended, liver palpable just below costal angle \nGU: deferred \nExt: Warm, well-perfused, no ___ edema \nNeuro: Non-focal, no asterixis \nSkin: Jaundice, no spider angioma \n\nDischarge Exam\nVS: 98.3, 105/60, 80, 18, 99RA\nGEN: A+Ox3 in NAD, lying in bed comfortbly\nHEENT: minimal scleral icterus. PEERLA, no nystagmus present\nCardiac: RRR, no MRG\nPulm: CTAB\nAbd: soft, nondistended. No palpable liver tip. no tenderness to \npalpation, no rebound or guarding, no fluid wave, no palpable \nspleen on exam\nExtremities: no lower extremity edema\nNeuro: no astereixis\nSkin: no rashes', 'diagnoses': [{'icd_code': 'I309', 'desc': 'Acute pericarditis, unspecified'}, {'icd_code': 'B20', 'desc': 'Human immunodeficiency virus [HIV] disease'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}], 'summary': 'Admission labs:\n___ 01:30AM BLOOD WBC-10.9 RBC-4.65 Hgb-15.5 Hct-48.2* \nMCV-104* MCH-33.4* MCHC-32.1 RDW-13.3 Plt ___\n___ 01:30AM BLOOD Neuts-80.5* Lymphs-14.9* Monos-3.6 \nEos-0.3 Baso-0.8\n___ 01:30AM BLOOD ___ PTT-39.5* ___\n___ 01:30AM BLOOD Glucose-124* UreaN-6 Creat-0.6 Na-137 \nK-3.8 Cl-99 HCO3-28 AnGap-14\n___ 01:30AM BLOOD ALT-705* AST-779* AlkPhos-191* \nTotBili-9.2* DirBili-7.3* IndBili-1.9\n\nPertinent labs:\n___ 01:30AM BLOOD Albumin-3.8\n___ 10:15AM BLOOD Iron-163*\n___ 01:30AM BLOOD Ferritn-1401*\n___ 10:15AM BLOOD calTIBC-285 VitB12-1798* Folate-15.4 \nTRF-219\n___ 10:15AM BLOOD TSH-0.25*\n___ 10:15AM BLOOD IgG-668* IgM-84\n___ 01:30AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG\n___ 08:10PM URINE Color-Yellow Appear-Hazy Sp ___\n___ 08:10PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-SM Urobiln-NEG pH-7.5 Leuks-NEG\n___ 08:10PM URINE UCG-NEGATIVE\n___ 08:10PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nDischarge labs:\n___ 07:20AM BLOOD WBC-PND RBC-4.16* Hgb-13.5 Hct-43.8 \nMCV-106* MCH-32.5* MCHC-30.8* RDW-13.4 Plt ___\n___ 07:20AM BLOOD ___ PTT-42.8* ___\n___ 07:20AM BLOOD Glucose-93 UreaN-4* Creat-0.7 Na-137 \nK-3.7 Cl-102 HCO3-28 AnGap-11\n___ 07:20AM BLOOD ALT-405* AST-298* AlkPhos-151* \nTotBili-5.5*\n___ 07:20AM BLOOD Calcium-8.9 Phos-3.6 Mg-2.1\n\nImaging:\nRUQ ultrasound ___: IMPRESSION: Echogenic portal triads \nsuggest acute hepatitis. No intra- or extra-hepatic biliary \nduct dilation. The common bile duct measures 3 mm. \n\nLabs pending on discharge:\n___ 01:30AM BLOOD HBsAg-PND HBsAb-NEGATIVE HBcAb-NEGATIVE \nHAV Ab-NEGATIVE IgM HAV-NEGATIVE\n___ 01:30AM BLOOD HCV Ab-POSITIVE*\n___ 07:43AM BLOOD Smooth-PND\n___ 07:43AM BLOOD ___\n___ 07:20AM BLOOD IgA-PND\n___ 10:15AM BLOOD tTG-IgA-PND\n___ 11:39AM BLOOD CERULOPLASMIN-PND\n___ 11:39AM BLOOD ALPHA-1-ANTITRYPSIN-PND\n___ 07:00AM BLOOD COPPER (SERUM)-PND\n___ 10:15AM BLOOD ANAPLASMA PHAGOCYTOPHILUM (HUMAN \nGRANULOCYTIC EHRLICHIA AGENT) IGG/IGM-PND\n___ 08:00AM BLOOD HERPES SIMPLEX VIRUS 1 AND 2 (IGG)-PND\nMs. ___ is a ___ yo F w/ PMH of fibromyalgia and depression \nwho presented with new onset jaundice likely likely due to acute \nHepatitis C.\n\n#Acute Hepatitis- patient with jaundice on exam, imaging \nevidence and elevated LFTs into the 700s with elevated bilirubin \nto 9.3 who presented with nausea and vomiting. No evidence on \nexam of chronic liver dysfunction. She had no ascites on exam \nand her labs were notable for preserved synthetic function. \nWorkup inpatient included testing for viral hepatitides, \nautoimmune hepatitis, hemachromatosis, wilsons. After the \npatient was discharged her HCV Ab came back positive. Therefore \ngiven that she denied previously being positive, this could \nrepresent acute hepatitis C. However the HCV viral load was \nstill pending at the time of discharge. The hepatology team is \ncontacting the patient to give her these results which would not \nchange her discharge or course. She will continue to need \nfollowup of her LFTs and hepatitis C testing. She will followup \nin the liver clinic for further workup which will likely include \ngenotype which was NOT sent while inpatient. Her LFTs were \ndowntrending at the time of discharge. She complained of \npruritis likely due to her hyperbilirubinemia. \n\n#Pain- patient was on oxycodone or hydrocone as an outpatient \nand diazepam. These medications were downtitrated while \ninpatient given her hepatic dysfunction and concern for stacking \nin this setting. She showed no signs of benzo withdrawal and had \nno benzos noted on her urine which was taken 24 hours following \nher admission.'}}
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{'final_diagnoses': ['Acute hepatitis C'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ yo F w/ PMH of fibromyalgia and depression \nwho presented with new onset jaundice likely likely due to acute \nHepatitis C.\n\n#Acute Hepatitis- patient with jaundice on exam, imaging \nevidence and elevated LFTs into the 700s with elevated bilirubin \nto 9.3 who presented with nausea and vomiting. No evidence on \nexam of chronic liver dysfunction. She had no ascites on exam \nand her labs were notable for preserved synthetic function. \nWorkup inpatient included testing for viral hepatitides, \nautoimmune hepatitis, hemachromatosis, wilsons. After the \npatient was discharged her HCV Ab came back positive. Therefore \ngiven that she denied previously being positive, this could \nrepresent acute hepatitis C. However the HCV viral load was \nstill pending at the time of discharge. The hepatology team is \ncontacting the patient to give her these results which would not \nchange her discharge or course. She will continue to need \nfollowup of her LFTs and hepatitis C testing. She will followup \nin the liver clinic for further workup which will likely include \ngenotype which was NOT sent while inpatient. Her LFTs were \ndowntrending at the time of discharge. She complained of \npruritis likely due to her hyperbilirubinemia. \n\n#Pain- patient was on oxycodone or hydrocone as an outpatient \nand diazepam. These medications were downtitrated while \ninpatient given her hepatic dysfunction and concern for stacking \nin this setting. She showed no signs of benzo withdrawal and had \nno benzos noted on her urine which was taken 24 hours following \nher admission.', 'medications_prescribed': ['OxycoDONE (Immediate Release) 20 mg PO Q8H:PRN pain', 'Sarna Lotion 1 Appl TP QID:PRN pruritis', 'Diazepam 10 mg PO Q8H:PRN spasm', 'Outpatient Lab Work\nICD9: 573.3\nObtain Complete metabolic panel the week of ___\nto be faxed to PCP: Dr. ___ fax number ___ and \nthe ___ ___ attn Dr. ___', 'OxycoDONE (Immediate Release) 20 mg PO Q8H:PRN pain', 'Sarna Lotion 1 Appl TP QID:PRN pruritis', 'Diazepam 10 mg PO Q8H:PRN spasm', 'Outpatient Lab Work\nICD9: 573.3\nObtain Complete metabolic panel the week of ___\nto be faxed to PCP: Dr. ___ fax number ___ and \nthe ___ ___ attn Dr. ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 42, 'gender': 'F', 'symptoms': 'Shortness of breath', 'medical_history': ['1. Nonspecific Interstitial Pneumonitis', '2. Systemic Lupus Erythematosus', '- atypical, ___ negative', '- s/p cytoxan', '- manifestations include osteoarthritis in her back, neck, \nwrists, and knuckles.', '3. Muscular dystrophy', '4. SIADH', '- occurs frequently in the setting of NSIP flares', '5. Depression', '6. Steroid-induced myopathy', '7. Hypothyroidism', '8. Migraine headaches', '9. Myofascial pain syndrome', '10. Cervical Cancer', '\x96 s/p TAH at age ___', '11. Seizure, unclear why, not during SIADH, in ___'], 'family_history': 'Cousin - SLE\nMother - carrier of muscular dystrophy, died of hepatocellular \ncarcinoma and autoimmune hepatitis; coronary artery disease\nFather - coronary artery disease', 'present_illness': 'Patient is a ___ yo woman with complex PMHx sig. for nonspecific \ninterstitial pneumonitis on high dose prednisone, SLE on Cytoxan \n(received 2nd dose 2 weeks ago), and muscular dystrophy who \npresents with worsening shortness of breath and chest pain over \nthe last 2 days. Two weeks ago, she had been tapering \nprednisone to 40 mg, developed chest tightness and SOB. She \nfollowed up with Dr. ___. The xray showed a LLL \npneumonitis. Her prednisone was increased to 80 mg daily, which \nhelped for a week. She then started to taper her prednisone \nagain. She got to 60 mg daily and re-developed SOB and chest \ntightness and had to increase her prednisone dose again. About \n1 week ago, she developed a deep, congested cough with yellow \nsputpum (which is not usual for her NSIP flares) and wheezing. \nShe called in to the Pulmonary clinic and was started on a 3 day \ncourse of Azithromycin 500 mg (last dose yesterday) with \nresolution of her cough. She has been taking 110 mg pred \nwithout improving and was referred in by her pulmonologist, Dr. \n___. She feels that if she had a CT scan of teh chest, it \nwould should a right LML flare but she defers a CT scan \ncurrently because she has had multiple scans in ___ past.\n\nIn the ED, initial VS were: afebrile, HR 112 > 104 without \nintervention, BP 157/99 RR 22 > 14 after settling down, 100% on \nRA. Labs were notable for WBC 8.4, Trop 0.02. The patient \nreceived dilaudid.', 'medications': [{'medication': 'Misoprostol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Etomidate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride (Powder)', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV BOLUS', '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': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': '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', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': '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': 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', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LaMOTrigine', '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': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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 MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': 0.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Potassium Chloride', '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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Misoprostol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', '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': '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': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine (Liquid)', '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': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Succinylcholine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID: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': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', '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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', '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': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Misoprostol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Methylene Blue 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Misoprostol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '234', 'valuenum': 234.0, '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': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', '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': '32.4', 'valuenum': 32.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.3,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': 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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '9', 'valuenum': 9.0, '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': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, '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': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, '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': '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': '86', 'valuenum': 86.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.3, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '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': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '4', 'valuenum': 4.0, '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': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, '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': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, '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': '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': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 59.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '37.2', 'valuenum': 37.2, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', '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': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '106', 'valuenum': 106.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '520', 'valuenum': 520.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '18/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, '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': '12', 'valuenum': 12.0, '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': '0.6', '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '10.7', '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': '35.0', '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': '260', 'valuenum': 260.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.45', 'valuenum': 3.45, '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': '7.6', 'valuenum': 7.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 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'33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '403', 'valuenum': 403.0, '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': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, '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': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '444', 'valuenum': 444.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', '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': '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': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, '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': '503', 'valuenum': 503.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '417', 'valuenum': 417.0, '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': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', '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': '32.2', 'valuenum': 32.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '75', 'valuenum': 75.0, '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': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '186', 'valuenum': 186.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '458', 'valuenum': 458.0, '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': '3.45', 'valuenum': 3.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '418', 'valuenum': 418.0, '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': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, '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': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '253', 'valuenum': 253.0, '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': '2.52', 'valuenum': 2.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, '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': '___', 'valuenum': 5.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '80', 'valuenum': 80.0, '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': 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 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 675.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '___', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY. ANION GAP VERIFIED.'}, {'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': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '333', 'valuenum': 333.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.92', 'valuenum': 2.92, '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': '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': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.7', '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': '4.0', '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', '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': '33.6', 'valuenum': 33.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '294', 'valuenum': 294.0, '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': '2.91', 'valuenum': 2.91, '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': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '317', 'valuenum': 317.0, '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': '2.94', 'valuenum': 2.94, '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': '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '328', 'valuenum': 328.0, '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': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '34.2', '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': '330', 'valuenum': 330.0, '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': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '344', 'valuenum': 344.0, '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': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '12.4', 'valuenum': 12.4, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1104', 'valuenum': 1104.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '31.0', 'valuenum': 31.0, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '403', 'valuenum': 403.0, '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': '2.91', 'valuenum': 2.91, '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': '25.7', 'valuenum': 25.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '426', 'valuenum': 426.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, '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': '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': 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': '___', 'valuenum': 2.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '0.5', 'valuenum': 0.5, 'valueuom': '%', 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None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, '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': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49', 'valuenum': 49.0, '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': '56', 'valuenum': 56.0, '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': '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': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 167.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '251', 'valuenum': 251.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.0', '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', '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': '29.5', 'valuenum': 29.5, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.99, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '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': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, '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': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': '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': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '444', 'valuenum': 444.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, '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': '12.7', 'valuenum': 12.7, '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': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '420', 'valuenum': 420.0, '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': '2.60', 'valuenum': 2.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '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': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 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': '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': '3.0', '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.1', 'valuenum': 22.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '746', 'valuenum': 746.0, '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': '2.46', 'valuenum': 2.46, '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}], 'exams': 'Vitals: 97.6, 170/114, 103, 16, 99RA\nGen: NAD, AOX3, Cushingoid appearance \nHEENT: MMM, sclera anicteric, L eye injected\nNeck: no LAD, no JVD\nCardiovascular: RRR normal s1, s2, no murmurs appreciated\nRespiratory: Upper lobe squeaks on the left, no crackles \nAbd: normoactive bowel sounds, soft, non-tender, non distended \nExtremities: 1+ edema bilaterally, 2+ DP pulses\nNeuro: face symmetric, tongue midline\nIntegument: Warm, moist, no rash or ulceration \nPsychiatric: appropriate, pleasant, not anxious', 'diagnoses': [{'icd_code': '53989', 'desc': 'Other complications of other bariatric procedure'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '48241', 'desc': 'Methicillin susceptible pneumonia due to Staphylococcus aureus'}, {'icd_code': '1120', 'desc': 'Candidiasis of mouth'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '53440', 'desc': 'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'E9359', 'desc': 'Unspecified analgesic and antipyretic causing adverse effects in therapeutic use'}, {'icd_code': 'V4586', 'desc': 'Bariatric surgery status'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '6924', 'desc': 'Contact dermatitis and other eczema due to other chemical products'}], 'summary': '___ 02:30PM WBC-8.4# RBC-4.51 HGB-13.8 HCT-41.9 MCV-93 \nMCH-30.6 MCHC-32.9 RDW-15.3\n___ 02:30PM NEUTS-92* BANDS-0 LYMPHS-4* MONOS-4 EOS-0 \nBASOS-0 ___ MYELOS-0\n___ 02:30PM PLT SMR-HIGH PLT COUNT-470*\n___ 02:30PM GLUCOSE-106* UREA N-23* CREAT-0.4 SODIUM-131* \nPOTASSIUM-5.2* CHLORIDE-94* TOTAL CO2-31 ANION GAP-11\n___ 02:30PM CALCIUM-9.2 PHOSPHATE-4.0 MAGNESIUM-2.2\n___ 02:30PM cTropnT-0.02*\n\nCXR:\nPersistent L lingula opacity c/w known history of pneumonitis.\n\nECG:\nNSR at 110 bpm. Q waves in III and AVF (old). No acute \nischemic changes.\n.\n___ 11:04AM BLOOD WBC-7.1 RBC-4.12* Hgb-12.4 Hct-39.0 \nMCV-95 MCH-30.1 MCHC-31.8 RDW-15.2 Plt ___\n___ 11:04AM BLOOD Glucose-168* UreaN-19 Creat-0.5 Na-132* \nK-4.8 Cl-94* HCO3-28 AnGap-15\n___ 11:10AM BLOOD TSH-0.\nyo woman with complex PMHx sig. for nonspecific interstitial \npneumonitis on high dose prednisone, SLE on Cytoxan (received \n2nd dose 2 weeks ago), and muscular dystrophy who presented with \nworsening shortness of breath and chest pain over the last 2 \ndays. There was no new infiltrate on CXR and no leukocytosis. \nPt refused Chest CT and she had already completed a 3 day course \nof high dose azithromycin with resolution of her cough. She was \nruled out for MI with 2 sets of negative cardiac enzymes and \nPulmonary was consulted. Pt was started on empiric IV \nsolumedrol with Bactrim & fluconazole PPx. Over the following \ntwo days, pt had improvement in symptoms with decreased SOB and \nchest pain. Pt underwent PFTs and the final report was pending \nat the time of discharge. Pt was seen by her primary \npulmonologist on the day of discharge who agreed that she was \nstable for discharge and air travel. Pt agreed to plan for \nanother 5 days of prednisone 100mg daily and starting a slow \ntaper the following week. Pt was continued on Ca/D and will be \nfollowing up with Dr. ___ in 2 weeks. \n\n# Muscular dystrophy: Pt was seen by ___ and they felt she was \nstable for discharge to home but recommended ongoing outpt \nphysical therapy. Pt was given a script and reports will be \nforwarded to her primary MD.\n\n# Hypertension: BP was elevated with mild tachycardia, likely \nworsened by high dose steroids and ongoing NSAID use. Pt was \ncontinued losartan and labetalol 200mg BID was added for \nadditional BP and HR control. Pt was encouraged to discuss the \nlabetalol with her PCP as it may not be needed after the steroid \nwean is completed. Pt was instructed to avoid NSAIDs while on \nhigh dose steroids and continue home regimen of lasix 20mg daily \nas needed for lower extremity edema.\n\n# Hyponatremia: Patient has h/o of SIADH and Na remained at \nbaseline of 132 while in house. \n# Depression: stable, continued on home regimen of \ncymbalta/seroquel\n# Hypothyroidism: TSH, maintained on home dose.\n# SLE: continued on Plaquenil.'}}
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{'final_diagnoses': ['Non specific interstitial pneumonitis flare', 'Atypical SLE', 'Hypothyroid', 'Muscular Dystrophy'], 'procedures': ['None'], 'visit_summary': 'yo woman with complex PMHx sig. for nonspecific interstitial \npneumonitis on high dose prednisone, SLE on Cytoxan (received \n2nd dose 2 weeks ago), and muscular dystrophy who presented with \nworsening shortness of breath and chest pain over the last 2 \ndays. There was no new infiltrate on CXR and no leukocytosis. \nPt refused Chest CT and she had already completed a 3 day course \nof high dose azithromycin with resolution of her cough. She was \nruled out for MI with 2 sets of negative cardiac enzymes and \nPulmonary was consulted. Pt was started on empiric IV \nsolumedrol with Bactrim & fluconazole PPx. Over the following \ntwo days, pt had improvement in symptoms with decreased SOB and \nchest pain. Pt underwent PFTs and the final report was pending \nat the time of discharge. Pt was seen by her primary \npulmonologist on the day of discharge who agreed that she was \nstable for discharge and air travel. Pt agreed to plan for \nanother 5 days of prednisone 100mg daily and starting a slow \ntaper the following week. Pt was continued on Ca/D and will be \nfollowing up with Dr. ___ in 2 weeks. \n\n# Muscular dystrophy: Pt was seen by ___ and they felt she was \nstable for discharge to home but recommended ongoing outpt \nphysical therapy. Pt was given a script and reports will be \nforwarded to her primary MD.\n\n# Hypertension: BP was elevated with mild tachycardia, likely \nworsened by high dose steroids and ongoing NSAID use. Pt was \ncontinued losartan and labetalol 200mg BID was added for \nadditional BP and HR control. Pt was encouraged to discuss the \nlabetalol with her PCP as it may not be needed after the steroid \nwean is completed. Pt was instructed to avoid NSAIDs while on \nhigh dose steroids and continue home regimen of lasix 20mg daily \nas needed for lower extremity edema.\n\n# Hyponatremia: Patient has h/o of SIADH and Na remained at \nbaseline of 132 while in house. \n# Depression: stable, continued on home regimen of \ncymbalta/seroquel\n# Hypothyroidism: TSH, maintained on home dose.\n# SLE: continued on Plaquenil.', 'medications_prescribed': ['1. Seroquel 50 mg Tablet Sig: One (1) Tablet PO twice a day.', '2. alprazolam 1 mg Tablet Sig: One (1) Tablet PO QHS (once a day \n(at bedtime)) as needed for insomnia.', '3. losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours).', '5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO BID (2 times a day).', '8. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '9. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) \nTablet PO 3X/WEEK (___).', '10. Plaquenil 200 mg Tablet Sig: One (1) Tablet PO twice a day.', '11. prednisone 50 mg Tablet Sig: Two (2) Tablet PO once a day: \nthrough ___, then decrease to 80mg daily until ___, \nthen wean per Dr. ___. ', '12. tramadol 50 mg Tablet Sig: ___ Tablets PO three times a day: \nas needed for breakthrough pain.', '13. labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).\nDisp:*60 Tablet(s)* Refills:*2*', '14. Outpatient Physical Therapy\nPlease provide a functional assessment and therapy. Please send \nreports to PCP ___ # ___', '15. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day as \nneeded for ankle swelling.']}
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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': 'Dehydration', 'medical_history': ['HTN', 'HLD', 'Diverticulitis', 'horseshoe kidney', 'atypical liver lesion seen on CT scan', 'hypoattenuating lesion on left kidney seen on CT scan', 'cyst in scrotum removed', 'tonsillectomy', 'diverticulitis'], 'family_history': 'Mother with lung cancer. Father has history of CAD', 'present_illness': "Per admission note:\n\nMr. ___ is a ___ well known to colorectal service who is s/p\nlaparoscopic coverted to open partial left colectomy with \nprimary\nstapled coloproctostomy and diverting loop ileostomy on ___ for recurrent diveticulitis, presents after recent discharge for\ncontinued high ostomy ouput and episode of low blood pressure. \nOf\nnote, patient's recent left colectomy was complicated by a wound\ninfection and an intrabdominal abscess in the LLQ requiring ___ drainage and discharge on a VAC. He returned to on ___ with \nhigh\nostomy output, emesis and dehydration. He was treated with NGT\ndecompression and fluid resuscitation and was discharged home on\n___. Patient states since his discharge he's been continuing\nto have high ostomy output (1.5-2L/day), fairly watery but\nunchanged in consistency, no blood. He's been trying to keep up\nwith the high output by drinking gatorade. Today, his SBP was\nnoted to be consistently in the ___ when measured by his home\nnurse, however he was asymptomatic. He is directly admitted for\nassessment and observation. Denies fevers/chills. No abdominal\npain/nausea/vomiting/melena/blood in ostomy.", 'medications': [{'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': 'BREAKFAST', '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': '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': '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fish Oil (Omega 3)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'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 via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', '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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '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': '513', 'valuenum': 513.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '46', 'valuenum': 46.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 231.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '535', 'valuenum': 535.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.8, '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '0.50', 'valuenum': 0.5, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', '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': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 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': '61', 'valuenum': 61.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, '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': '14.6', 'valuenum': 14.6, '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': '0.03', 'valuenum': 0.03, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.17', 'valuenum': 0.17, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.59', 'valuenum': 0.59, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', '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': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, '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*. SOME LARGE.'}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.40', 'valuenum': 0.4, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 162.0, 'valueuom': 'mg/dL', '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': 3.8, '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': 145.0, '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': '6.3', 'valuenum': 6.3, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, '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': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '46', 'valuenum': 46.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '335', 'valuenum': 335.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': 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': '12', 'valuenum': 12.0, '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': '0.76', 'valuenum': 0.76, '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': '5.8', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, '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': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.11', 'valuenum': 0.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.35', 'valuenum': 0.35, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.63', 'valuenum': 0.63, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '46.0', 'valuenum': 46.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'At Admission:\n\nPhysical Exam:\nVS: 98.4, 97, 123/87, 20, 98% RA\nGEN: WDWN,NAD \nCV: RRR, no M/R/G\nPULM: CTAB\nAbd: Soft, nontender, nondistended, abd wound - lower part of\nmidline wound wet-do-dry dressings on ~4cm long 1-1.5 cm deep,\nwell granulated tissue.\n\nAt Discharge\nGeneral: Tolerating a regular diet, + ___\nAbd: Ileostomy takedown site clean/dry/intact, minimal abdominal \npain, abdomen nondistended.', 'diagnoses': [{'icd_code': 'D702', 'desc': 'Other drug-induced agranulocytosis'}, {'icd_code': 'M868X7', 'desc': 'Other osteomyelitis, ankle and foot'}, {'icd_code': 'L97419', 'desc': 'Non-pressure chronic ulcer of right heel and midfoot with unspecified severity'}, {'icd_code': 'T361X5A', 'desc': 'Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E1142', 'desc': 'Type 2 diabetes mellitus with diabetic polyneuropathy'}, {'icd_code': 'R5081', 'desc': 'Fever presenting with conditions classified elsewhere'}, {'icd_code': 'M109', 'desc': 'Gout, unspecified'}, {'icd_code': 'D6959', 'desc': 'Other secondary thrombocytopenia'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'L409', 'desc': 'Psoriasis, unspecified'}, {'icd_code': 'E11621', 'desc': 'Type 2 diabetes mellitus with foot ulcer'}], 'summary': "___ 05:46AM BLOOD WBC-7.8 RBC-3.47* Hgb-10.0* Hct-28.6* \nMCV-83 MCH-28.8 MCHC-34.9 RDW-14.4 Plt ___\n___ 07:03AM BLOOD WBC-8.1 RBC-3.37* Hgb-9.3* Hct-27.5* \nMCV-82 MCH-27.7 MCHC-33.9 RDW-14.7 Plt ___\n___ 04:00PM BLOOD WBC-9.9 RBC-3.79* Hgb-10.9* Hct-30.2* \nMCV-80* MCH-28.7 MCHC-36.0* RDW-14.7 Plt ___\n___ 05:46AM BLOOD Plt ___\n___ 07:03AM BLOOD ___ PTT-27.8 ___\n___ 07:03AM BLOOD Plt ___\n___ 04:00PM BLOOD Plt ___\n___ 05:46AM BLOOD Glucose-119* UreaN-10 Creat-0.7 Na-135 \nK-4.1 Cl-101 HCO3-25 AnGap-13\n___ 07:03AM BLOOD Glucose-102* UreaN-13 Creat-0.8 Na-138 \nK-4.4 Cl-107\n___ 06:40AM BLOOD Glucose-105* UreaN-31* Creat-1.0 Na-136 \nK-4.9 Cl-109* HCO3-17* AnGap-15\n___ 06:30AM BLOOD Glucose-115* UreaN-55* Creat-1.7*# Na-133 \nK-5.3* Cl-105 HCO3-15* AnGap-18\n___ 04:00PM BLOOD Glucose-121* UreaN-59* Creat-3.0*# \nNa-123* K-5.3* Cl-95* HCO3-15* AnGap-18\n___ 05:46AM BLOOD Calcium-9.0 Phos-4.1 Mg-1.9\n___ 07:03AM BLOOD Calcium-9.9 Phos-3.8 Mg-1.6\n___ 06:40AM BLOOD Calcium-9.6 Phos-3.7 Mg-1.9\n___ 06:30AM BLOOD Calcium-9.9 Phos-5.0*# Mg-2.2\n___ 04:00PM BLOOD Calcium-10.1 Phos-6.6*# Mg-2.1\n\n POUCHOGRAM Study Date of ___ 10:02 AM \nFINDINGS: After a scout image was obtained, a 16 ___ Foley \ncatheter was inserted into the rectum and advanced. 110 cc's of \ncontrast was gently hand injected. Contrast was seen filling \nthe rectum and then passing beyond the anastomotic site without \nevidence of holdup. No extraluminal contrast was noted. \nPost-evacuation scout image showed no evidence of a leak. \nIMPRESSION: \nNo evidence of an anastomotic leak. \n\nCHEST (PORTABLE AP) Study Date of ___ 2:22 ___ \nFINDINGS: Portable AP chest radiograph. The lungs are clear. \nThere is no pleural effusion or pneumothorax. The \ncardiomediastinal silhouette is normal. \nIMPRESSION: No acute cardiopulmonary process.\nOn ___ Mr. ___ was admitted to the Inpatient Colorectal \nSurgery Service with dehydration related to high ileostomy \noutput. Of note, the patient's creatinine was 3.0. The patient \nwas given a bolus of intravenous fluids and hydrated with \ncontinuous fluids. He was tolerating a regular diet without \nissue. On ___ the patient continued to have low blood \npressure and was again given a fluid bolus. He was given an \nincreased rate of intravenous fluids. The patient had been \npreviously treated for dehydration and his ileostomy output was \nproving difficult to control on an outpatient basis. A \npouchogram was ordered to assess the pouch for leak with the \nhopes of ileostomy reversal during this admission as the patient \nwas having significant dehydration with acute kidney injury. The \npouchogram showed stool in the rectum and because of this the \ncontrast was not able to fully reach the anastomosis. The study \nwould be repeated after removing this stool. On ___ the \npatient received a fleet enema x2 with good affect. His \nileostomy output remained elevated and the Imodium was \nincreased. The patient was monitored closely and fluids were \ngiven appropriately. His creatinine improved at the patient was \nhydrated. On ___ the pouchogram was repeated and was \nnegative for a leak. The patient's fluid balance was improved. \nOn ___ the patient was taken to the operating room for an \nileostomy reversal. He tolerated he procedure well and was \ntransferred back to the inpatient unit for recovery. ___ \nthe patient tolerated clear liquids however had not demonstrated \nbowel function. Post-operative laboratory values were stable and \nthe patient was given intravenous fluids and pain medications as \nappropriate. On ___ the patient demonstrated bowel function \nand his diet was advanced to regular . He tolerated food well. \nHe was discharged home when meeting all discharge criteria."}}
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{'final_diagnoses': ['Unwanted ileostomy have surgical managment of Diverticulitis'], 'procedures': ['Ileostomy Takedown'], 'visit_summary': "On ___ Mr. ___ was admitted to the Inpatient Colorectal \nSurgery Service with dehydration related to high ileostomy \noutput. Of note, the patient's creatinine was 3.0. The patient \nwas given a bolus of intravenous fluids and hydrated with \ncontinuous fluids. He was tolerating a regular diet without \nissue. On ___ the patient continued to have low blood \npressure and was again given a fluid bolus. He was given an \nincreased rate of intravenous fluids. The patient had been \npreviously treated for dehydration and his ileostomy output was \nproving difficult to control on an outpatient basis. A \npouchogram was ordered to assess the pouch for leak with the \nhopes of ileostomy reversal during this admission as the patient \nwas having significant dehydration with acute kidney injury. The \npouchogram showed stool in the rectum and because of this the \ncontrast was not able to fully reach the anastomosis. The study \nwould be repeated after removing this stool. On ___ the \npatient received a fleet enema x2 with good affect. His \nileostomy output remained elevated and the Imodium was \nincreased. The patient was monitored closely and fluids were \ngiven appropriately. His creatinine improved at the patient was \nhydrated. On ___ the pouchogram was repeated and was \nnegative for a leak. The patient's fluid balance was improved. \nOn ___ the patient was taken to the operating room for an \nileostomy reversal. He tolerated he procedure well and was \ntransferred back to the inpatient unit for recovery. ___ \nthe patient tolerated clear liquids however had not demonstrated \nbowel function. Post-operative laboratory values were stable and \nthe patient was given intravenous fluids and pain medications as \nappropriate. On ___ the patient demonstrated bowel function \nand his diet was advanced to regular . He tolerated food well. \nHe was discharged home when meeting all discharge criteria.", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H pain \nDo not take more than 3000mg of tylenol in 24 hours or drink \nalcohol while taking \nRX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) \nhours Disp #*45 Tablet Refills:*0', '2. Atenolol 25 mg PO DAILY ', '3. Lorazepam 1 mg PO Q8H:PRN anxiety \nplease dicuss with your primary care provider tapering and \neventually stopping this medication ', '4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \ndo not drink alcohol or drive a car while taking \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*50 Tablet Refills:*0', '5. Sertraline 50 mg PO DAILY ', '6. Simvastatin 20 mg PO DAILY ', '7. Aquacel Hydrofiber Dressing (hydrocolloid dressing) 4 X 4 \nTopical daily \napply to wound base after shower, apply dry sterile gauze over \nand secure with paper tape \nRX *hydrocolloid dressing [Aquacel Hydrofiber Dressing] 4" X 4"\napply to wound base once daily once a day Disp #*30 Each \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'M', 'symptoms': 'Entire left side has "fallen asleep"', 'medical_history': ['T1DM (insulin pump) c/b diabetic retinopathy', 'b/l knee arthroplasty', 'depression, anxiety', 'HTN', 'HLD'], 'family_history': 'No family history of stroke or autoimmune disease', 'present_illness': 'Ms. ___ is a ___ yo woman w/PMH type 1 DM with insulin pump,\nhypothyroidism, HLD who presented initially to ___ today w/\nhemiparathesias and subsequently was referred to the ED for\nfurther workup. \n\nMs. ___ was in usual state of health until this morning, \nwhen\nshe woke up feeling like her entire left side had "fallen \nasleep". She endorses both tingling and numbness in her left\nface, arm, and leg. Last night when she went to bed she was not\nhaving these symptoms. She reports that she initially thought\nthis was because she may have slept abnormally, so she went \nabout\nher day as per usual, stating that she had a normal day at work\n(works at ___). She denies any weakness,\ndifficulty ambulating, dysarthria, vision changes, confusion, or\nchanges to her voice associated with this. She has no neck or\nback pain and denies recent trauma.', 'medications': [{'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS: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}]}, 'clinical_findings': {'labs': [{'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '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': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.0', 'valuenum': 1.0, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: afebrile, BP 98.4, HR 84, BP 148/80 \n General: well appearing woman in no apparent distress \n HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted \nin\noropharynx \n Neck: Supple, no carotid bruits appreciated. No nuchal rigidity \n\n Pulmonary: Lungs CTA bilaterally without R/R/W \n Cardiac: RRR, nl. S1S2, no M/R/G noted \n Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or\norganomegaly noted. \n Extremities: No ___ edema. \n Skin: evidence of fairly diffuse subcutaneous edema \n\n Neurologic: \n -Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name ___ backward without\ndifficulty. Language is fluent with intact repetition and\ncomprehension. Normal prosody. There were no paraphasic errors.\nPt was able to name both high and low frequency objects. Able to\nread without difficulty. Speech was not dysarthric. Able to\nfollow both midline and appendicular commands. Pt was able to\nregister 3 objects and recall ___ at 5 minutes. There was no\nevidence of apraxia or neglect. \n -Cranial Nerves: \n II, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without\nnystagmus. Normal saccades. VFF to confrontation. Visual acuity\n___ bilaterally. \n V: Facial sensation decreased to light touch on left lower face \n\n VII: No facial droop, facial musculature symmetric. \n VIII: Hearing intact to finger-rub bilaterally. \n IX, X: Palate elevates symmetrically. \n XI: ___ strength in trapezii and SCM bilaterally. \n XII: Tongue protrudes in midline. \n\n -Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally. No adventitious movements, such as tremor, noted.\nNo asterixis noted. \n\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\n -Sensory: Decreased sensation to pink and light touch over left\nlower face, left deltoid, left lateral thigh, and foot. poor\ndiscrimination (pin v blunt tip of total LUE). vibration\nsensation and position sense intact. \n\n -DTRs: \n Bi Tri ___ Pat Ach \nL ___ 0 1 \nR ___ 0 1 \n Plantar response was flexor bilaterally. \n\n -Coordination: No intention tremor, no dysdiadochokinesia \nnoted.\nNo dysmetria on FNF or HKS bilaterally. \n\n -Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Able to walk in tandem without difficulty. Romberg \nabsent.', 'diagnoses': [{'icd_code': '29690', 'desc': 'Unspecified episodic mood disorder'}], 'summary': "___ 07:35AM BLOOD WBC-6.5 RBC-4.21 Hgb-12.4 Hct-38.0 MCV-90 \nMCH-29.5 MCHC-32.6 RDW-12.3 RDWSD-40.1 Plt ___\n___ 08:55PM BLOOD Neuts-64.4 ___ Monos-5.7 Eos-1.8 \nBaso-0.7 Im ___ AbsNeut-5.41 AbsLymp-2.29 AbsMono-0.48 \nAbsEos-0.15 AbsBaso-0.06\n___ 07:35AM BLOOD ___ PTT-31.2 ___\n___ 07:35AM BLOOD Glucose-158* UreaN-16 Creat-0.8 Na-140 \nK-4.5 Cl-105 HCO3-24 AnGap-11\n___ 03:15PM BLOOD ALT-34 AST-23 CK(CPK)-102 AlkPhos-101 \nTotBili-0.5\n___ 07:35AM BLOOD Calcium-8.4 Phos-3.8 Mg-2.4\n___ 03:15PM BLOOD %HbA1c-7.0* eAG-154*\n___ 03:15PM BLOOD Triglyc-188* HDL-71 CHOL/HD-2.4 \nLDLcalc-59\n___ 03:15PM BLOOD TSH-1.4\n___ 03:15PM BLOOD Free T4-0.9*\n___ 06:00PM URINE Color-Straw Appear-CLEAR Sp ___\n___ 06:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose->1000* Ketone-NEG Bilirub-NEG Urobiln-NORMAL pH-6.0 \nLeuks-NEG\n___ 06:00PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG oxycodn-NEG mthdone-NEG\n___ right handed woman with history of DM1, HLD who woke up with left-sided numbness of her face arm and leg, that mostly resolved within 24 hrs, with a patch of ongoing numbness in the left lateral upper arm. She was admitted to the Neurology stroke service. \n\n#Left hemibody sensory changes\nMRI brain demonstrated a punctate focus of diffusion-weighted and FLAIR hyperintense signal with associated ADC hypointensity, thought to be an acute infarct. Demyelinating process was also on the differential consideration, but considered less likely given lack of associated enhancement. There was also noted to be a right frontal centrum semiovale 1 cm T2 hyperintense lesion with peripheral rim of FLAIR and diffusion-weighted hyperintense signal without enhancement which was nonspecific. LP was attempted without adequate CSF flow. MRI C- and T-spine demonstrated. Differential for this lesion included evolving infarct or demyelinating plaque. To try to determine if these lesions are ischemic or demyelinating in nature, we did an MRI of the spine to look for prior sequelae of inflammation. There were no old or enhancing demyelinating lesions identified on the spine, and no other old lesions on the brain to suggest MS. ___, we did not attempt to repeat LP. Working diagnosis acute infarct, and patient was started on Plavix, and continued on aspirin; after 3 weeks aspirin will be discontinued and she will remain on Plavix monotherapy indefinitely. There is a slight increased risk of bleeding with concurrent use of SSRIs and Plavix, and patient should follow up with PCP for regular hemoglobin checks. Though the punctate acute infarct is in a location classic for small vessel disease, the older infarct in the right frontal centrum semioval is not, and therefore patient will need outpatient telemetry monitoring. Patients echo-cardiogram was without etiologic cause. As it was a weekend when she was ready for discharge, this could not be arranged inpatient and patient will have to follow up as an outpatient for this monitoring. This was ordered in OMR; patient will be called to schedule which she understands. As an outpatient in stroke clinic, consideration should be given to repeat MRI w/wo contrast to see if additional lesions are accrued that would support change of working diagnosis to a demyelinating process. Additionally, if she were to experience new symptoms, additional neuroimaging should be obtained to further assess for stroke for demyelination. She was continued on simvastatin 40mg daily. \n\n#IDDM\nPatient's home insulin pump and home insulin was continued while inpatient. She ran out of insulin as she was being discharged, with plan to go directly home to pick up insulin. ___ was consulted and recommended no changes to home regimen.\n\n#Hypertension\nWhile hospitalized we held you anti-hypertensives to allow for post stroke permissive hypertension which are to be continued after discharge. \n\n#Hypothyroidism\nHome levothyroxine was continued without change. TSH and FT4 were within essentially normal limits. \n\n#Depression/Anxiety \n- continue home lamotrigine and sertraline. Follow up with PCP for hemoglobin check given initiation of Plavix as outpatient. \n- continue home methylphenidate \n\nHer stroke was most likely secondary to small vessel ischemia event given history of hypertension, hyperlipidemia, and stroke location. We did consider this a failure of ASA. She was started on Plavix 75mg daily with DAPT x3 weeks, with plan to discontinue aspirin after 3 weeks. Her deficits improved greatly prior to discharge and the only notable deficit was slightly decreased pinprick in the left lateral upper arm. She did not require ___ consult, and was discharged home with outpatient follow up. \nHer stroke risk factors include the following:\n1) DM: A1c 7%\n2) No intracranial atherosclerosis \n3) Hyperlipidemia: well controlled on simvastatin 40 with LDL 59\n4) Obesity - not applicable, followed by endocrinology for DM1\n5) Sleep apnea - she does not yet carry the diagnosis\nAn echocardiogram did not show PFO.\n\nAHA/ASA Core Measures for Ischemic Stroke and Transient Ischemic Attack\n1. Dysphagia screening before any PO intake? (x) Yes, confirmed done - () Not confirmed () No. If no, reason why:\n2. DVT Prophylaxis administered? (x) Yes - () No. If no, why not (I.e. bleeding risk, hemorrhage, etc.)\n3. Antithrombotic therapy administered by end of hospital day 2? (x) Yes - () No. If not, why not? (I.e. bleeding risk, hemorrhage, etc.)\n4. LDL documented? (x) Yes (LDL = 59\n5. Intensive statin therapy administered? (simvastatin 80mg, simvastatin 80mg/ezetemibe 10mg, atorvastatin 40mg or 80 mg, rosuvastatin 20mg or 40mg, for LDL > 70) (x) Yes - () No [if LDL >70, reason not given:\n[ ] Statin medication allergy\n[ ] Other reasons documented by physician/advanced practice nurse/physician ___ (physician/APN/PA) or pharmacist\n[ ] LDL-c less than 70 mg/dL\n6. Smoking cessation counseling given? () Yes - (x) No [reason (x) non-smoker - () unable to participate]\n7. Stroke education (personal modifiable risk factors, how to activate EMS for stroke, stroke warning signs and symptoms, prescribed medications, need for followup) given in written form? (x) Yes - () No\n8. Assessment for rehabilitation or rehab services considered? () Yes - (x) No. Patient at functional baseline. \n9. Discharged on statin therapy? () Yes - () No [if LDL >70, reason not given:\n[ ] Statin medication allergy\n[ ] Other reasons documented by physician/advanced practice nurse/physician ___ (physician/APN/PA) or pharmacist\n[ ] LDL-c less than 70 mg/dL\n10. Discharged on antithrombotic therapy? (x) Yes [Type: (x) Antiplatelet - () Anticoagulation] - () No\n11. Discharged on oral anticoagulation for patients with atrial fibrillation/flutter? () Yes - () No - If no, why not (I.e. bleeding risk, etc.) (x) N/A"}}
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{'final_diagnoses': ['Cerebral Infarction'], 'procedures': ['Bilateral Knee arthroplasty'], 'visit_summary': "___ right handed woman with history of DM1, HLD who woke up with left-sided numbness of her face arm and leg, that mostly resolved within 24 hrs, with a patch of ongoing numbness in the left lateral upper arm. She was admitted to the Neurology stroke service. \n\n#Left hemibody sensory changes\nMRI brain demonstrated a punctate focus of diffusion-weighted and FLAIR hyperintense signal with associated ADC hypointensity, thought to be an acute infarct. Demyelinating process was also on the differential consideration, but considered less likely given lack of associated enhancement. There was also noted to be a right frontal centrum semiovale 1 cm T2 hyperintense lesion with peripheral rim of FLAIR and diffusion-weighted hyperintense signal without enhancement which was nonspecific. LP was attempted without adequate CSF flow. MRI C- and T-spine demonstrated. Differential for this lesion included evolving infarct or demyelinating plaque. To try to determine if these lesions are ischemic or demyelinating in nature, we did an MRI of the spine to look for prior sequelae of inflammation. There were no old or enhancing demyelinating lesions identified on the spine, and no other old lesions on the brain to suggest MS. ___, we did not attempt to repeat LP. Working diagnosis acute infarct, and patient was started on Plavix, and continued on aspirin; after 3 weeks aspirin will be discontinued and she will remain on Plavix monotherapy indefinitely. There is a slight increased risk of bleeding with concurrent use of SSRIs and Plavix, and patient should follow up with PCP for regular hemoglobin checks. Though the punctate acute infarct is in a location classic for small vessel disease, the older infarct in the right frontal centrum semioval is not, and therefore patient will need outpatient telemetry monitoring. Patients echo-cardiogram was without etiologic cause. As it was a weekend when she was ready for discharge, this could not be arranged inpatient and patient will have to follow up as an outpatient for this monitoring. This was ordered in OMR; patient will be called to schedule which she understands. As an outpatient in stroke clinic, consideration should be given to repeat MRI w/wo contrast to see if additional lesions are accrued that would support change of working diagnosis to a demyelinating process. Additionally, if she were to experience new symptoms, additional neuroimaging should be obtained to further assess for stroke for demyelination. She was continued on simvastatin 40mg daily. \n\n#IDDM\nPatient's home insulin pump and home insulin was continued while inpatient. She ran out of insulin as she was being discharged, with plan to go directly home to pick up insulin. ___ was consulted and recommended no changes to home regimen.\n\n#Hypertension\nWhile hospitalized we held you anti-hypertensives to allow for post stroke permissive hypertension which are to be continued after discharge. \n\n#Hypothyroidism\nHome levothyroxine was continued without change. TSH and FT4 were within essentially normal limits. \n\n#Depression/Anxiety \n- continue home lamotrigine and sertraline. Follow up with PCP for hemoglobin check given initiation of Plavix as outpatient. \n- continue home methylphenidate \n\nHer stroke was most likely secondary to small vessel ischemia event given history of hypertension, hyperlipidemia, and stroke location. We did consider this a failure of ASA. She was started on Plavix 75mg daily with DAPT x3 weeks, with plan to discontinue aspirin after 3 weeks. Her deficits improved greatly prior to discharge and the only notable deficit was slightly decreased pinprick in the left lateral upper arm. She did not require ___ consult, and was discharged home with outpatient follow up. \nHer stroke risk factors include the following:\n1) DM: A1c 7%\n2) No intracranial atherosclerosis \n3) Hyperlipidemia: well controlled on simvastatin 40 with LDL 59\n4) Obesity - not applicable, followed by endocrinology for DM1\n5) Sleep apnea - she does not yet carry the diagnosis\nAn echocardiogram did not show PFO.\n\nAHA/ASA Core Measures for Ischemic Stroke and Transient Ischemic Attack\n1. Dysphagia screening before any PO intake? (x) Yes, confirmed done - () Not confirmed () No. If no, reason why:\n2. DVT Prophylaxis administered? (x) Yes - () No. If no, why not (I.e. bleeding risk, hemorrhage, etc.)\n3. Antithrombotic therapy administered by end of hospital day 2? (x) Yes - () No. If not, why not? (I.e. bleeding risk, hemorrhage, etc.)\n4. LDL documented? (x) Yes (LDL = 59\n5. Intensive statin therapy administered? (simvastatin 80mg, simvastatin 80mg/ezetemibe 10mg, atorvastatin 40mg or 80 mg, rosuvastatin 20mg or 40mg, for LDL > 70) (x) Yes - () No [if LDL >70, reason not given:\n[ ] Statin medication allergy\n[ ] Other reasons documented by physician/advanced practice nurse/physician ___ (physician/APN/PA) or pharmacist\n[ ] LDL-c less than 70 mg/dL\n6. Smoking cessation counseling given? () Yes - (x) No [reason (x) non-smoker - () unable to participate]\n7. Stroke education (personal modifiable risk factors, how to activate EMS for stroke, stroke warning signs and symptoms, prescribed medications, need for followup) given in written form? (x) Yes - () No\n8. Assessment for rehabilitation or rehab services considered? () Yes - (x) No. Patient at functional baseline. \n9. Discharged on statin therapy? () Yes - () No [if LDL >70, reason not given:\n[ ] Statin medication allergy\n[ ] Other reasons documented by physician/advanced practice nurse/physician ___ (physician/APN/PA) or pharmacist\n[ ] LDL-c less than 70 mg/dL\n10. Discharged on antithrombotic therapy? (x) Yes [Type: (x) Antiplatelet - () Anticoagulation] - () No\n11. Discharged on oral anticoagulation for patients with atrial fibrillation/flutter? () Yes - () No - If no, why not (I.e. bleeding risk, etc.) (x) N/A", 'medications_prescribed': ['Clopidogrel 75 mg PO DAILY', 'Insulin Pump SC (Self Administering Medication)\nTarget glucose: 80-180', 'Aspirin 81 mg PO DAILY', 'ClonazePAM 0.5 mg PO QHS', 'LamoTRIgine 200 mg PO BID', 'Levothyroxine Sodium 50 mcg PO 50 MCG, 100MCG ON ___ \nAND ___', 'liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous DAILY', 'Losartan Potassium 100 mg PO DAILY', 'lysine 500 mg oral DAILY', 'MethylPHENIDATE (Ritalin) 10 mg PO QAM', 'Metoprolol Succinate XL 25 mg PO DAILY', 'Sertraline 150 mg PO DAILY', 'Simvastatin 40 mg PO QPM', 'Vitamin B Complex 1 CAP 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': 23, 'gender': 'M', 'symptoms': 's/p fall', 'medical_history': ['CKD (baseline crt 1.3)', 'diabetes melitus, type II', 'GERD', 'hyperlipidemia', 'carpal tunnel', 'hiatal hernia', 'tobacco use', 'mild dementia per ___ note from prior admission'], 'family_history': 'per OMR: Brother with DM since age ___, ESRD on HD.', 'present_illness': ' ___ yo woman with PMH of CKD, DM, GERD, HLD who fell out of \nbed yesterday and was found to have SAH and possible small IPH \ncomponent on CT. Reports that she was rolling out of bed to go \nbrush her teeth when she suddenly ended up on the floor. She \ndoes not recall hitting her head, but says it is possible. No \nLOC. Had some mild lower back pain and crawled back into bed. \nCalled EMS because she was worried she may have injured herself. \n. \nHas no complaints now other than lower back pain. CT showed \nright F/T and occipital SAH and possible IPH component. \n. \nBlood sugar was 39 on arrival. She has been erroneously taking \nGlucophage the last month or so. Was to have discontinued after \n___ admission, but is confused about her medications \nand \nhad continued to take the glucophage.', 'medications': [{'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': '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': '6.5', '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': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': 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. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '9', 'valuenum': 9.0, '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': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '24', 'valuenum': 24.0, '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': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, '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': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.49', 'valuenum': 4.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '281', 'valuenum': 281.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '212', 'valuenum': 212.0, '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': '360', 'valuenum': 360.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '95', 'valuenum': 95.0, '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 = >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': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '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': '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': '35.1', 'valuenum': 35.1, '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': 'POSITIVE. TITER IS BETWEEN 15 AND 100 MIU/ML. PROTECTIVE TITERS ARE >10 MIU/ML.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE. RECOMMENDED FOLLOW-UP FOR POSITIVE HCV ANTIBODY: HCV VIRAL LOAD.'}, {'value': '808', 'valuenum': 808.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'AVAILABLE AT THE ___ LAB.'}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '390', 'valuenum': 390.0, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 59.0, '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': 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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': '<5*.'}, {'value': '989', 'valuenum': 989.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '___', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'CORRECTED RESULT PREVIOUSLY REPORTED AS 2.'}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '278', 'valuenum': 278.0, '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': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, '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': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '927', 'valuenum': 927.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '350', 'valuenum': 350.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '___', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', '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': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '35.9', 'valuenum': 35.9, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': '33', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'CORRECTED RESULT PREVIOUSLY REPORTED AS 2.'}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '419', 'valuenum': 419.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '263', 'valuenum': 263.0, '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': '328', 'valuenum': 328.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', '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': 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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<5*.'}, {'value': '854', 'valuenum': 854.0, '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', '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': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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}], 'exams': "Tmax 100.1 Tc 98.5 100/40-60 16 99%RA \nGen: comfortable, NAD. \nHEENT: EOMI, PERRL \nLungs: CTA bilaterally. \nCardiac: RRR. no m/r/g \nAbd: Soft, NT, BS+ \nExtrem: Warm and well-perfused, no edema \nNeuro: alert, oriented to self and year. unsure of name of \nhospital but knows it's a hospital. asks same question several \ntimes in same conversation. sometimes answers questions \nappropriately, poor attention. Not able to count backwards from \n10 or do months backwards. easily names objects including \n___ and telephone. Strength intact. Appears to have \nvisual field deficit in LUQ. difficult exam ___ poorly able to \nfollow directions. continually asking to move to room 212.", 'diagnoses': [{'icd_code': '78060', 'desc': 'Fever, unspecified'}, {'icd_code': '78096', 'desc': 'Generalized pain'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '78079', 'desc': 'Other malaise and fatigue'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '2839', 'desc': 'Acquired hemolytic anemia, unspecified'}, {'icd_code': '31401', 'desc': 'Attention deficit disorder with hyperactivity'}, {'icd_code': 'V5864', 'desc': 'Long-term (current) use of non-steroidal anti-inflammatories (NSAID)'}], 'summary': "___ 08:05PM WBC-8.9# RBC-3.73* HGB-9.9* HCT-31.1* MCV-83 \nMCH-26.5* MCHC-31.8 RDW-17.9*\n___ 08:05PM NEUTS-81.5* LYMPHS-14.9* MONOS-3.2 EOS-0.2 \nBASOS-0.1\n___ 08:05PM PLT COUNT-320#\n___ 08:05PM ___ PTT-22.1 ___\n___ 08:05PM GLUCOSE-39* UREA N-16 CREAT-1.2* SODIUM-139 \nPOTASSIUM-5.5* CHLORIDE-104 TOTAL CO2-27 ANION GAP-14\n___ 08:05PM CK(CPK)-139\n___ 08:05PM cTropnT-0.01\n___ 08:05PM CK-MB-3\n___ 11:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 11:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-250 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-NEG\n___ 11:30PM URINE ___ BACTERIA-NONE YEAST-NONE \n___ RENAL ___\nDILANTIN LEVEL 14.1 on ___\n\nBlood culture x1 no growth to date at the time of discharge\n\nCT HEAD ___: IMPRESSION: Right occipitotemporal \nintraparenchymal hemorrhage with possible subarchnoid component \nand small right temporal and frontal subarachnoid hemorrhage. \n\nCT HEAD ___: IMPRESSION: Stable right occipitotemporal \nintraparenchymal hemorrhage with possible subarachnoid component \nand unchanged frontal subarachnoid hemorrhage. No new focus of \nintracranial hemorrhage. \n\nCT CHEST ___: IMPRESSION: \n1. Increasing compression of T11 vertebral body with worsening \nsclerosis. \nGiven interval worsening since recent CT, acute trauma is of \nconcern. This \nwas discussed with Dr. ___. \n2. Coronary artery and aortic arch calcifications without \nevidence of acute aortic injury/syndrome. \n3. Unchanged pulmonary nodules. \n\nCXR ___: IMPRESSION: \n1. No acute cardiopulmonary process. \n2. Multiple thoracic compression defomrities with worsening \ncompression of a vertebral body in the region of T11, may be \nacute. Recommend clinical correlation for point tenderness at \nthis site. \n\nCT SPINE ___: IMPRESSION: \n1. No acute fracture seen. Extensive multilevel DJD as described \nabove \ncausing moderate-to-severe neural foraminal narrowing and \nmild-to-moderate \ncentral canal stenosis. \n2. Small 4.7 mm right thyroid lobe nodule which could be further \nevaluatd \nwith ultrasound. \n\nSpeech and Swallow recs: RECOMMENDATIONS:\n1. PO diet: regular solids, thin liquids\n2. PO meds whole with thin liquids as tolerated\n3. BID oral care\n4. Assist with meals only as needed to maintain standard\naspiration precautions.\n5. Encourage d/c to a facility in which she would have \nassistance\nwith meal preparation and further cognitive linguistic dx/tx to\nmaximize function.\nThese recommendations were shared with the patient, nurse and\nmedical team.\nIntracranial Hemorrhage: pt initially admitted to neurosurgery \nand followed x24 hours c repeat head CT at 24 hour mark. Pt \nnoted to have visual field cut in LUQ which corresponds to area \nof intraparenchymal hemorrhage. ICH remained stable and pt \ntransferred to medicine with further follow up with neurosurgeon \nin 4 weeks.\n-DILANTIN LEVEL SHOULD BE MONITORED CLOSELY \n.\n#delerium/dementia: Pt noted to be delerious. This was felt to \nlikely be secondary to her intracranial hemorrhage. Pt did have \ncxr and UA that were unremarkable. Pt also had cardiac enzymes \nnegative x1. She also had a single set of blood cultures pending \nat the time of discharge. Delerium improved throughout admission \nand pt was calm and oriented x1-3 on discharge. Pt had also been \nnoted to have a mild dementia on prior admissions, per pt's \nneighbor and sister she had been doing less well at home over \nthe past few months which was felt to represent worsening \ndementia. TSH, B12 and RPR were checked and were all within \nnormal limits. \n. \n# ___: Pt developed acute kidney injury with peak creatinine of \n1.5. This had resolved with gentle IVF within 24h. On discharge \npt's Cr was 0.9 and pt had not recieved IVF in 48 hours. \n. \n# sp fall: tylenol for pain \n. \n#dm: hypoglycemic on admission in setting of pt taking metformin \ndespite the medication being discontinued on prior admission. \nContinued to not give metformin. Pt placed on very gentle \ninsulin sliding scale. \n. \n#thyroid nodule: noted incidentally: small 4.7 mm right thyroid \nlobe nodule which could be further evaluated with ultrasound. \nTSH was checked and was within normal limits.\n-PLEASE ARRANGE FOR OUTPATIENT FOLLOW UP FOR FURTHER EVALUATION \n.\n# DISPO: pt has h/o mild dementia and many recent falls. When \nacute issues surrounding intracranial hemorrhage have resolved.\n.\n# full code. Pt. has twin sister, ___ home ___ and \ncell ___."}}
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{'final_diagnoses': ['primary: intracranial bleed'], 'procedures': ['none'], 'visit_summary': "Intracranial Hemorrhage: pt initially admitted to neurosurgery \nand followed x24 hours c repeat head CT at 24 hour mark. Pt \nnoted to have visual field cut in LUQ which corresponds to area \nof intraparenchymal hemorrhage. ICH remained stable and pt \ntransferred to medicine with further follow up with neurosurgeon \nin 4 weeks.\n-DILANTIN LEVEL SHOULD BE MONITORED CLOSELY \n.\n#delerium/dementia: Pt noted to be delerious. This was felt to \nlikely be secondary to her intracranial hemorrhage. Pt did have \ncxr and UA that were unremarkable. Pt also had cardiac enzymes \nnegative x1. She also had a single set of blood cultures pending \nat the time of discharge. Delerium improved throughout admission \nand pt was calm and oriented x1-3 on discharge. Pt had also been \nnoted to have a mild dementia on prior admissions, per pt's \nneighbor and sister she had been doing less well at home over \nthe past few months which was felt to represent worsening \ndementia. TSH, B12 and RPR were checked and were all within \nnormal limits. \n. \n# ___: Pt developed acute kidney injury with peak creatinine of \n1.5. This had resolved with gentle IVF within 24h. On discharge \npt's Cr was 0.9 and pt had not recieved IVF in 48 hours. \n. \n# sp fall: tylenol for pain \n. \n#dm: hypoglycemic on admission in setting of pt taking metformin \ndespite the medication being discontinued on prior admission. \nContinued to not give metformin. Pt placed on very gentle \ninsulin sliding scale. \n. \n#thyroid nodule: noted incidentally: small 4.7 mm right thyroid \nlobe nodule which could be further evaluated with ultrasound. \nTSH was checked and was within normal limits.\n-PLEASE ARRANGE FOR OUTPATIENT FOLLOW UP FOR FURTHER EVALUATION \n.\n# DISPO: pt has h/o mild dementia and many recent falls. When \nacute issues surrounding intracranial hemorrhage have resolved.\n.\n# full code. Pt. has twin sister, ___ home ___ and \ncell ___.", 'medications_prescribed': ['1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours) as needed for pain. ', '3. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale \nSubcutaneous three times a day. ', '4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day. ', '6. Miralax 17 gram/dose Powder Sig: One (1) PO once a day: hold \nfor loose stool. ']}
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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': 'Bilateral stones', 'medical_history': ['Prior stones', 'Hypercalciuria and hyperoxaluria', 'Right ureteroscopy this ___'], 'family_history': None, 'present_illness': '___ is a ___ male with acute onset of bilateral back\npain and microhematuria. His imaging here suggests a left renal\npelvic stone and possible bilateral ureteral stones.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': 'NAD\nAbd soft nt/nd\nExt wwp', 'diagnoses': [{'icd_code': '541', 'desc': 'Appendicitis, unqualified'}], 'summary': "___ 09:50AM UREA N-13 CREAT-1.1 SODIUM-139 POTASSIUM-4.1 \nCHLORIDE-99 TOTAL CO2-31 ANION GAP-13\n___ 09:50AM estGFR-Using this\nThe patient was admitted to Dr. ___ service \nfollowing his procedure. He tolerated the procedure well and \nthere were no complications; please see operative note for more \ndetails. Post operatively was voiding without difficulty, and \nhis pain was controlled. He was tolerating a regular diet. He \nwas given Toradol and Flomax to help facilitate passage of his \nstones and started on hydrochlorothiazide. At discharge, \npatient's pain well controlled with oral pain medications, \ntolerating regular diet, ambulating without assistance, and \nvoiding without difficulty. He is given explicit instructions to \ncall Dr. ___ follow-up and additional stone \nprocedures."}}
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{'final_diagnoses': ['Bilateral ureteral stent placement'], 'procedures': ['Cystoscopy, bilateral retrograde pyelogram, bilateral ureteral \nstent placment'], 'visit_summary': "The patient was admitted to Dr. ___ service \nfollowing his procedure. He tolerated the procedure well and \nthere were no complications; please see operative note for more \ndetails. Post operatively was voiding without difficulty, and \nhis pain was controlled. He was tolerating a regular diet. He \nwas given Toradol and Flomax to help facilitate passage of his \nstones and started on hydrochlorothiazide. At discharge, \npatient's pain well controlled with oral pain medications, \ntolerating regular diet, ambulating without assistance, and \nvoiding without difficulty. He is given explicit instructions to \ncall Dr. ___ follow-up and additional stone \nprocedures.", 'medications_prescribed': ['Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp \n#*30 Capsule Refills:*0', 'Hydrochlorothiazide 25 mg PO BID \nRX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', 'Tamsulosin 0.4 mg PO HS \nRX *tamsulosin 0.4 mg 1 capsule,extended release 24hr(s) by \nmouth at bedtime Disp #*30 Capsule Refills:*0', 'OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth q6 hr Disp #*45 Tablet \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 20, 'gender': 'F', 'symptoms': 'anemia', 'medical_history': ['1. Coronary artery disease \n-Non Q wave MI in ___ s/p stenting of the diagonal branch of \nthe LAD and mid RCA\n-s/p exercise stress with perfusion study showing no fixed or \nreversible defects and borderline EKG changes in ___\n-Last Echo ___ with EF>60%', '2. Mild mitral regurgitation', '3. Hyperlipidemia', '4. Hypertension', '5. Dynamic outflow track obstruction', "6. Last Colonoscopy: Diverticulosis, hemorrhoids, and AVM's", '7. Chronic constipation', '8. Anemia'], 'family_history': 'Her mother died at ___ from "lung problems" for which she had \nbeen hospitalized many times. Her father died at ___ from a \nbleeding ulcer. She denies either of them having heart \nproblems, cancer, diabetes, thyroid disease, neurologic disease, \nor rheumatologic disease. She has 2 brothers and 2 sisters, one \nof whom is a twin who is healthy.', 'present_illness': '___ with history of anemia, atrial fibrillation on apixaban, \nCAD, who presents after referral from PCP for anemia. Patient \nstates she has been in her usual state of health. Noted slight \nfatigue ___. She visited her PCP the next day who \ndrew bloodwork. This returned with a significant anemia with \nhemoglobin below 7 so she was referred to the ED. Of note, she \nstates that she has not noted any presyncopal symptoms \npreviously. She has no dyspnea. She has noted streaks of red \nblood on toilet paper but no hematochezia, dark stook or \nhematemesis. She has no abdominal pain. She has no other \nbleeding or bruising. She states she does take iron. She notes \nchronic problems with hemorrhoids.', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amoxicillin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Erythromycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Dibucaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxytocin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Tetanus-DiphTox-Acellular Pertuss (Adacel)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Codeine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Betamethasone Sodium Phos/Acet', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IM', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amoxicillin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nephrocaps', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H: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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90.0', 'valuenum': 90.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '379', 'valuenum': 379.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '423', 'valuenum': 423.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, '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': '34.8', 'valuenum': 34.8, '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': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.6', 'valuenum': 88.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '361', 'valuenum': 361.0, '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': '2.97', 'valuenum': 2.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, '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': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '3.6', 'valuenum': 3.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85.6', 'valuenum': 85.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '360', 'valuenum': 360.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', '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': '1.013', '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '7.8', 'valuenum': 7.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70.7', 'valuenum': 70.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '345', 'valuenum': 345.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, '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': 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': '5', 'valuenum': 5.0, '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': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, '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': '76.3', 'valuenum': 76.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '426', 'valuenum': 426.0, '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': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76.2', 'valuenum': 76.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '348', 'valuenum': 348.0, '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': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '470', 'valuenum': 470.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '343', 'valuenum': 343.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '392', 'valuenum': 392.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, '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': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.4', 'valuenum': 32.4, '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': '5.9', 'valuenum': 5.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.4', 'valuenum': 79.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '330', 'valuenum': 330.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '467', 'valuenum': 467.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 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': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '6.1', 'valuenum': 6.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77.8', 'valuenum': 77.8, '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': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam:\nitals: 98.8 120/52 68 18 100%RA\nGeneral: pleasant, well appearing, appears stated age, no acute \ndistress\nHEENT: pale mucous membranes\nLymph: no lad\nCV: irregular bradycardic, ___ murmur at lower left sternal \nborder\nLungs: CTAB/L no wheezes, rhonchi, rales\nAbdomen: mild distended, soft, nontender, normoactive bowel \nsounds\nGU: no foley\nExt: WWP, 1+ pitting edema to the shins\nNeuro: moving all extremities\nSkin: no bruising\nRectal: guaiac positive brown stool, hemorrhoids\n\nDischarge Physical Exam:\nVitals: 82 135/55 20 98% RA\nGeneral: pleasant, well appearing, appears stated age, no acute \ndistress\nHEENT: pale mucous membranes\nLymph: no lad\nCV: irregular bradycardic, ___ murmur at lower left sternal \nborder\nLungs: CTAB/L no wheezes, rhonchi, rales\nAbdomen: mild distended, soft, nontender, normoactive bowel \nsounds\nGU: no foley\nExt: WWP, 1+ pitting edema to the shins\nNeuro: moving all extremities, AAOx ___, states ___ but \nthinks she is in a hotel\nSkin: no bruising', 'diagnoses': [{'icd_code': '65821', 'desc': 'Delayed delivery after spontaneous or unspecified rupture of membranes, delivered, with or without mention of antepartum condition'}, {'icd_code': '2710', 'desc': 'Glycogenosis'}, {'icd_code': '64421', 'desc': 'Early onset of delivery, delivered, with or without mention of antepartum condition'}, {'icd_code': '65451', 'desc': 'Cervical incompetence, delivered, with or without mention of antepartum condition'}, {'icd_code': '64761', 'desc': 'Other viral diseases in the mother, delivered, with or without mention of antepartum condition'}, {'icd_code': 'V707'}, {'icd_code': 'V270'}, {'icd_code': '05410', 'desc': 'Genital herpes, unspecified'}, {'icd_code': '64891', 'desc': 'Other current conditions classifiable elsewhere of mother, delivered, with or without mention of antepartum condition'}], 'summary': 'Admission Labs:\n--------------\n\n___ 03:00PM ___ UREA ___ \n___ TOTAL ___ ANION ___\n___ 03:00PM LD(LDH)-184 TOT ___ DIR ___ INDIR \n___\n___ 03:00PM ___\n___ 03:00PM ___ VIT ___ \n___\n___ 03:00PM ___ \n___\n___ 03:00PM ___ \n___\n___ 03:00PM ___ \n___ \n___\n___ 03:00PM PLT ___ PLT ___\n___ 03:00PM ___ ___\n___ 03:00PM RET ___\n\nDischarge Labs:\n--------------\n___ 06:05AM BLOOD ___ \n___ Plt ___\n___ 06:05AM BLOOD Plt ___\n___ with PMH of chronic anemia, atrial fibrillation, CAD who \npresents with 4 days of fatigue, small amount of blood in stool, \nfound to have hemoglobin of 5.9 no findings on EGD. Colonscopy \nwith poor prep but no clear explanation for anemia. Reiculocyte \ncount with inadequate response.\n\n# GI Bleed - Has history of slow GI bleed per old notes. Most \nrecent colonoscopy showed angioectasias, grade 1 internal \nvarices but this scope was in ___. Has also had history of \ndiverticulosis. Previous EGDs have been unremarkable and no \nevidence as of yet of upper GI source. Seemed unlikely to be \nbrisk bleed given lack of evidence of blood and minimal symptoms \nof patient. No findings on EGD. Colonoscopy without findings to \nexplain anemia but of note patient had poor prep. Retic count \nsuggested poor bone marrow response. She received 2 units pRBCs \nand H/H improved. \n\n# Tachycardia: Patient on tele, afib not present. Likely \nsecondary to anemia. \n- Continue tele\n- restart atenolol PRN\n\n# Anemia - Normocytic anemia, iron deficiency. Likely related to \nslow GI losses though description per patient of amount of blood \nis unremarkable. Denied vaginal or urinary bleeding. Denied \nhematemesis. Because of the unclear etiology should have a \nworkup for further causes of anemia. Blood with hypochromic \ncells with some tear drops on manual smear.\n- hemolysis labs- normal \n- b12- 528, folate normal\n- check retic count- inappropriately low \n- check iron ___\n- patient may need heme referral on discharge\n\n# Lower extremity edema - Per patient new in onset. Has no \nprevious history of heart failure. Not on diuretics, not taking \ncalcium channel blockers. Most likely etiology would be \nextravasation of fluid related to low oncotic pressure due to \nsevere anemia.\n- transfuse per above\n- will need follow up with PCP/cardiologist to determine whether \nshe needs diuresis\n\nChronic Issues:\n--------------\n# CAD - Has history of MI. Because of this is at higher risk of \ncomplications from anemia. No chest pain currently. EKG \nunremarkable, but notable for bradycardia.\n- held atenolol as can mask hemodynamic response to anemia\n- held aspirin for possible bleed\n- continued atorvastatin\n\n# Hypertension - Per clinic notes patient with sbps in \n___. Now with pressure in 120s. Unclear if related to \nbleeding.\n- held lisinopril as at risk of bleeding, restarted on discharge\n\n# Atrial fibrillation - CHAADS2 of 2. Has been taking \nsubtherapeutic amount of apixaban for three months. Already took \ndose of apixaban on day of admission\n- held apixaban for now, was started on dabigatran on discharge\n- hold atenolol for concern for bleed and masking tachycardic \nresponse, restarted on discharge.'}}
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{'final_diagnoses': ['Anemia', 'Atrial fibrillation'], 'procedures': ['EGD', 'Colonoscopy'], 'visit_summary': '___ with PMH of chronic anemia, atrial fibrillation, CAD who \npresents with 4 days of fatigue, small amount of blood in stool, \nfound to have hemoglobin of 5.9 no findings on EGD. Colonscopy \nwith poor prep but no clear explanation for anemia. Reiculocyte \ncount with inadequate response.\n\n# GI Bleed - Has history of slow GI bleed per old notes. Most \nrecent colonoscopy showed angioectasias, grade 1 internal \nvarices but this scope was in ___. Has also had history of \ndiverticulosis. Previous EGDs have been unremarkable and no \nevidence as of yet of upper GI source. Seemed unlikely to be \nbrisk bleed given lack of evidence of blood and minimal symptoms \nof patient. No findings on EGD. Colonoscopy without findings to \nexplain anemia but of note patient had poor prep. Retic count \nsuggested poor bone marrow response. She received 2 units pRBCs \nand H/H improved. \n\n# Tachycardia: Patient on tele, afib not present. Likely \nsecondary to anemia. \n- Continue tele\n- restart atenolol PRN\n\n# Anemia - Normocytic anemia, iron deficiency. Likely related to \nslow GI losses though description per patient of amount of blood \nis unremarkable. Denied vaginal or urinary bleeding. Denied \nhematemesis. Because of the unclear etiology should have a \nworkup for further causes of anemia. Blood with hypochromic \ncells with some tear drops on manual smear.\n- hemolysis labs- normal \n- b12- 528, folate normal\n- check retic count- inappropriately low \n- check iron ___\n- patient may need heme referral on discharge\n\n# Lower extremity edema - Per patient new in onset. Has no \nprevious history of heart failure. Not on diuretics, not taking \ncalcium channel blockers. Most likely etiology would be \nextravasation of fluid related to low oncotic pressure due to \nsevere anemia.\n- transfuse per above\n- will need follow up with PCP/cardiologist to determine whether \nshe needs diuresis\n\nChronic Issues:\n--------------\n# CAD - Has history of MI. Because of this is at higher risk of \ncomplications from anemia. No chest pain currently. EKG \nunremarkable, but notable for bradycardia.\n- held atenolol as can mask hemodynamic response to anemia\n- held aspirin for possible bleed\n- continued atorvastatin\n\n# Hypertension - Per clinic notes patient with sbps in \n___. Now with pressure in 120s. Unclear if related to \nbleeding.\n- held lisinopril as at risk of bleeding, restarted on discharge\n\n# Atrial fibrillation - CHAADS2 of 2. Has been taking \nsubtherapeutic amount of apixaban for three months. Already took \ndose of apixaban on day of admission\n- held apixaban for now, was started on dabigatran on discharge\n- hold atenolol for concern for bleed and masking tachycardic \nresponse, restarted on discharge.', 'medications_prescribed': ['1. Atorvastatin 40 mg PO QPM', '2. Docusate Sodium 100 mg PO BID', '3. Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0', '4. Atenolol 12.5 mg PO DAILY', '5. Ferrous Sulfate 325 mg PO DAILY', '6. Lisinopril 40 mg PO DAILY', '7. Lorazepam 0.5 mg PO QHS:PRN sleep', '8. Nitroglycerin SL 0.4 mg SL PRN chest pain', '9. Vitamin D 1000 UNIT PO DAILY', '10. Outpatient Lab Work\nCBC ___: 285.9\nPlease fax to ___, fax: ___', '11. Dabigatran Etexilate 150 mg PO BID \nRX *dabigatran etexilate [Pradaxa] 150 mg 1 capsule(s) by mouth \ntwice a day Disp #*60 Capsule Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'F', 'symptoms': 'Weakness', 'medical_history': ['As per admitting MD:\nPAST ONCOLOGIC HISTORY:\n-___: saw PCP, ___ noted 5cm mass inferior,\nlateral to right nipple. Prior mammogram was ___. In ___,', "pt had GI sx and wt loss and after extensive work up for months\nshe was diagnosed with Addison's dz so missed her mammogram. In\n___ she did notice a R breast mass but did not seek \nmedical\nattention.", '-___: Mammogram at ___: Right breast -\n40x34x31 irreg high density mass central outer right breast at\nmid depth assoc with calcs. Marker placed. Left breast - 5mm\nasymmetry in subareolar slightly inner.', '-___: Ultrasound at ___: Right breast - 8:00 , 6cm\nfrom nipple hypoechoic irregular mass with post acoustic\nenhancement 3.4x 2.9x 2.7cm. Correlates to dominant mass on\n___. R axilla adenopathy present, ultrasound recommended. Left\nbreast - 5mm slight inner - additional imaging with ___ and \nu/s\nrecommended.', '-___: Bilateral diagnostic mammogram at ___\nTissue density: C. \nLEFT breast: The patient was recalled for evaluation of an\nasymmetry in the subareolar, slightly medial left breast at\nanterior depth, which does not persist with additional views,\nconsistent with superimposition of benign parenchyma. ___\nsuspicious mass, unexplained architectural distortion or \nsuspicious grouped microcalcifications in the left breast. \nRIGHT breast: There is a spiculated mass in the lower outer \nright\nbreast at middle depth with associated internal amorphous,\ncoarse heterogeneous and linear calcifications, which do not\nextend beyond the margins of the mass. \nOtherwise, ___ additional suspicious mass, unexplained\narchitectural distortion or suspicious grouped\nmicrocalcifications. There is mild skin thickening of the\ninferior, lateral right breast. \n ', "-___: BILATERAL BREAST ULTRASOUND at ___: \nLEFT: There is ___ suspicious solid or cystic mass from the 6\no'clock to the 12 o'clock retroareolar positions. At the 3 \no'clock position the left breast 3 cm from the nipple, there is\nan oval mass with circumscribed margins measuring 5 x 4 x 3 mm\nwith posterior acoustic enhancement and anechoic to low level\nhypoechoic internal echoes as well as absent internal\nvascularity on color Doppler. This mass does not correspond \nwith the mammographic asymmetry. \nRIGHT: There are 2 lymph nodes in the deep right axilla with\neccentric cortical thickening, measuring up to 11 mm. \nAdditional normal appearing right axillary lymph nodes without \nevidence of eccentric cortical thickening are noted. ", "-___: US guided core bx of R breast mass w HydroMark clip\nplacement and FNA of axillary node w clip placement as well as \nbx\nof L breast lesion w clip placement-path-\n1. R breast mass at 8'0 clock- grade 3 IDC with high grade DCIS,\nER neg (<1%), PR neg (0%), HER2 equivocal (+2) by ___, FISH\nPOS by ALT probe (HER2 copies 5.33, HER2/CEP17 ratio 1.9,\nHER2/p53 ratio 2.8)\n2. R axillary node-positive for malignant cells\n3. L breast lesion at 3'o clock-Fibroadenoma", '-___: CT chest and abdomen-4 mm left upper lobe pulmonary\nnodule is indeterminate bears watching. ___ evidence of\nintra-abdominal metastases.', '-___: Echo - Normal biventricular wall thickness, cavity\nsize, and regional/global systolic function. Mild-moderate \nmitral\nregurgitation. Mild-moderate tricuspid regurgitation. Mild\npulmonary artery systolic hypertension. EF >55%', '-___: Bone scan -___ evidence of bony metastases', '-___: C1 of ddAC', '-___: C2 of ddAC', '-___: C3 delayed secondary to acute onset of chest pain the\nmorning of chemotherapy', '-___: C3 DDAC', '-___: C4 ddAC', '1. COPD', '2. Hypothyroidism', "3. Addison's disease followed by Dr. ___ at ___", '4. Hyperlipidemia', '5. R hearing loss', '6. Hx of recurrent cysts on R breast nipple-areolar complex,\nlikely epidermal inclusion cysts', '7. Cataracts', '8. Mild-Mod MR/TR noted on echo'], 'family_history': 'As per admitting MD\n___ known family history of cancer.', 'present_illness': 'As per admitting MD:\n___ yo w/ breast cancer on neoadjuvant ddAC, COPD, Addisons\ndisease, hypothyroidism, and, HLD who is admitted from the ED\nwith weakness and generalized malaise. \n\nPatient received her fourth cycle of ddAC last ___ with\nNeulasta OnPro support. She felt well on ___, but by ___\nwas not feeling well. She noted feeling very weak, tired, and\ngenerally unwell. This feeling progressed into ___ and\npersisted all week. She felt so weak she could hardly get out of\nbed and felt faint while walking. She noted subjective chills \nbut\n___ night sweats, rigors, or known fevers. ___ CP, SOB or cough.\nShe has moderate nausea with bloating but ___ emesis. Her \nappetite\nhas been fair. She has been having normal bowel movements. ___\ndysuria. ___ new rashes or joint pains. ___ leg swelling. She \nnotes\neach successive round of her chemotherapy has been progressively\nmore difficult to recover from. Given her history of Addisons,\nshe increased her hydrocortisone to 25mg/10 mg daily from\n12.5mg/5mg following her chemo. She also increased her\nfludrocortisone to 0.2mg over the last few days.\n\nIn the ED, initial VS were pain 2, T 97.5, HR 110, BP 125/69, RR\n18, O2 100% RA. Initial labs notable for Na 138, K 4.3, HCO3 25,\nCr 0.7, Ca 9.3, Mg 1.6, P 3.7, ALT 15, AST 12, ALP 113, TBili\n0.3, Alb 3.7, TSH 2.9, UA negative. CXR showed ___ acute process.\nShe was given 1L NS, 100mg po hydrocortisone, and home\natorvastatin. VS prior to transfer were pain 0, T 98.9, HR 87, \nBP\n118/61, RR 16, O2 96%RA. \n\nOn arrival to the floor, patient reports feeling much improved.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'sucralfate', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROcodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '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': '___', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely decreases this test.'}, {'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': '___', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . estimated GFR (eGFR) is likely between 68 and >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 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': '224', 'valuenum': 224.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-76', 'valuenum': -76.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.55', 'valuenum': 0.55, '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': '3.3', 'valuenum': 3.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, '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': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.0', 'valuenum': 82.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '504', 'valuenum': 504.0, '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': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.35', 'valuenum': 0.35, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.87', 'valuenum': 0.87, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.61', 'valuenum': 8.61, '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': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, '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': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '48.7', 'valuenum': 48.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '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': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '143', 'valuenum': 143.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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', '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': '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': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '388', 'valuenum': 388.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.3', 'valuenum': 49.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '421', 'valuenum': 421.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.7', 'valuenum': 50.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission:\n___: Pleasant and well appearing, lying in bed comfortably\nEYES: Anicteric sclerea, PERLL, EOMI; \nENT: Oropharynx clear without lesion, JVD not elevated \nCARDIOVASCULAR: Regular rate and rhythm, ___ murmurs, rubs, or\ngallops; 2+ radial pulses\nRESPIRATORY: Appears in ___ respiratory distress, clear to\nauscultation bilaterally, ___ crackles, wheezes, or rhonchi\nGASTROINTESTINAL: Normal bowel sounds; nondistended; soft,\nnontender without rebound or guarding; ___ hepatomegaly, ___\nsplenomegaly\nMUSKULOSKELATAL: Warm, well perfused extremities without lower\nextremity edema; Normal bulk \nNEURO: Alert, oriented, CN III-XII intact, motor and sensory\nfunction grossly intact\nSKIN: ___ significant rashes\nLYMPHATIC: ___ cervical, supraclavicular, submandibular\nlymphadenopathy. ___ significant ecchymoses\n\nDischarge:\n___: Pleasant, sitting in bed comfortably, appears calm\nEYES: Anicteric sclera, PERLL \nENT: Oropharynx clear without lesion, MMM \nCARDIOVASCULAR: Regular rate and rhythm, normal distal perfusion\nwith warm extremities\nRESPIRATORY: Appears in ___ respiratory distress, clear to\nauscultation bilaterally, ___ crackles, wheezes, or rhonchi\nGASTROINTESTINAL: Normal bowel sounds; nondistended; soft,\nnontender without rebound or guarding\nMUSKULOSKELATAL: Warm, well perfused extremities without lower\nextremity edema; Normal bulk, ___ deformity\nNEURO: Alert, oriented, motor and sensory function grossly \nintact\nSKIN: ___ significant rashes', 'diagnoses': [{'icd_code': 'C786', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'R188', 'desc': 'Other ascites'}, {'icd_code': 'J9811', 'desc': 'Atelectasis'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C801', 'desc': 'Malignant (primary) neoplasm, unspecified'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'M329', 'desc': 'Systemic lupus erythematosus, unspecified'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'K5730', 'desc': 'Diverticulosis of large intestine without perforation or abscess without bleeding'}, {'icd_code': 'G6289', 'desc': 'Other specified polyneuropathies'}, {'icd_code': 'H401192', 'desc': 'Primary open-angle glaucoma, unspecified eye, moderate stage'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}], 'summary': "Admission:\n\n___ 06:00PM BLOOD WBC-0.9* RBC-2.84* Hgb-9.3* Hct-27.8* \nMCV-98 MCH-32.7* MCHC-33.5 RDW-13.9 RDWSD-49.4* Plt Ct-74*\n___ 06:00PM BLOOD Plt Smr-VERY LOW* Plt Ct-74*\n___ 06:00PM BLOOD Glucose-130* UreaN-17 Creat-0.7 Na-138 \nK-4.3 Cl-100 HCO3-25 AnGap-13\n___ 06:00PM BLOOD ALT-15 AST-12 AlkPhos-113* TotBili-0.3\n___ 06:00PM BLOOD Albumin-3.7 Calcium-9.3 Phos-3.7 Mg-1.6\n\nDischarge:\n\n___ 05:37AM BLOOD WBC-1.8* RBC-2.43* Hgb-7.9* Hct-24.1* \nMCV-99* MCH-32.5* MCHC-32.8 RDW-13.7 RDWSD-49.8* Plt Ct-57*\n___ 05:37AM BLOOD Neuts-51 Bands-3 ___ Monos-9 Eos-0 \nBaso-1 ___ Myelos-0 AbsNeut-0.97* AbsLymp-0.65* \nAbsMono-0.16* AbsEos-0.00* AbsBaso-0.02\n___ 05:37AM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 05:37AM BLOOD ___ PTT-28.1 ___\n___ 03:57PM BLOOD ___ 05:37AM BLOOD Glucose-93 UreaN-9 Creat-0.5 Na-145 K-4.0 \nCl-110* HCO3-25 AnGap-10\n___ 05:37AM BLOOD ALT-15 AST-10 AlkPhos-91 TotBili-0.2\n___ 05:37AM BLOOD Calcium-8.6 Phos-2.4* Mg-1.7 Iron-110\n___ 05:37AM BLOOD calTIBC-196* ___ Folate-7 \n___ Ferritn-501* TRF-151*\n\nImaging:\nCT A/P ___:\n \n1. ___ evidence of hemorrhage or other acute findings in the \nabdomen or pelvis. \n2. Superficial, 8 mm round intermediate density lesion in the \nregion of the \nright mons pubis is indeterminate, but may represent a sebaceous \ncyst. Please \ncorrelate with direct visualization and physical exam. \n\nCXR ___:\n___ acute cardiopulmonary process. \n \nMicro:\n\n___ 6:00 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: < 10,000 CFU/mL.\n___ PMH of Breast cancer (on neoadjuvant ddAC), COPD, Addisons \ndisease, hypothyroidism, HLD who was admitted from the ED with \nweakness and generalized malaise thought to be ___ insufficient \nsteroid replacement, whose hospital course was complicated by \nneutropenia/thrombocytopenia/anemia, who was discharged with \nclose outpatient oncology followup\n\n#Fatigue\n#Weakness\n#Addisons hx\nPatient presented with fatigue/weakness/malaise, without \ninfectious symptoms, or infectious process revealed on initial \nworkup. Labs revealed worsening \nneutropenia/thrombocytopenia/anemia, likely ___ cumulative \neffects of chemotherapy. As per outpatient discussion between \ndaughter and endocrinologist, it was thought that current \nsteroid dosing may be insufficient during off periods from \nchemo. Patient received IVF for 48 hrs. As per outpatient \nendocrinologist's discussion with daughter ___, I transitioned \nsteroid dosing to dexamethasone 2mg daily which patient \ntolerated well. As per endocrinologists recommendations she was \ninstructed to take 2mg daily but informed that she could split \nthe dosing into 1mg BID if she felt it was more successful in \ncontrolling malaise. She was continued on her normal dose of \nfludrocortisone.\n\n# Breast Cancer\n# Neutropenia\nPatient currently on neoadjuvant ddAC, with neutropenia as a \nresult of chemotherapy for which she received Neulasta OnPro. \nThroughout the course of her hospitalization her WBC improved \nslowly and she remained afebrile. At time of discharge her WBC \nwas 1.8K (51% PMN). Patient was instructed to f/u in ___ \nclinic on ___ to have her counts re-checked. \n\n# Anemia in malignancy\n# Thrombocytopenia\nPatient with profound new thrombocytopenia/anemia which is \nlikely ___ bone marrow suppression from cumulative chemotherapy \ndosing as retic count was low, haptoglobin normal, Fe studies \nwith high ferritin, low TIBC, coags wnl, smear without shistos. \nShe had ___ hx of bleeding/bruising or flank pain to suggest loss \nthrough bleeding either internal/external. However patient's \ndaughter felt that her abdomen was more bloated than usual so \nnon-con CT A/P ordered which did not reveal intra or \nretroperitoneal bleed. Patient was instructed to have her CBC \nre-checked at her next outpatient oncology followup appointment \nto ensure that she doesn't need a transfusion and that counts \nare rebounding appropriately. \n\nTransitional Issues:\n1. Patient is to have close outpatient f/u with her \nendocrinologist to trend her response to new dexamethasone \nregimen\n2. Patient is to have CBC checked at next outpatient oncology \nf/u apt on ___ to ensure that her platelets, WBC, and hemoglobin \nare rebounding. \n3. Patient found on CT to have a superficial, 8 mm round \nintermediate density lesion in the region of the right mons \npubis which was indeterminate, but may represent a sebaceous \ncyst. To be addressed/trended by dermatologist in outpatient \nsetting. Pt aware and in agreement with plan."}}
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{'final_diagnoses': ['Addisons disease with insufficient replacement dosing', 'Anemia', 'Thrombocytopenia', 'Neutropenia', 'Malaise'], 'procedures': ['None'], 'visit_summary': "___ PMH of Breast cancer (on neoadjuvant ddAC), COPD, Addisons \ndisease, hypothyroidism, HLD who was admitted from the ED with \nweakness and generalized malaise thought to be ___ insufficient \nsteroid replacement, whose hospital course was complicated by \nneutropenia/thrombocytopenia/anemia, who was discharged with \nclose outpatient oncology followup\n\n#Fatigue\n#Weakness\n#Addisons hx\nPatient presented with fatigue/weakness/malaise, without \ninfectious symptoms, or infectious process revealed on initial \nworkup. Labs revealed worsening \nneutropenia/thrombocytopenia/anemia, likely ___ cumulative \neffects of chemotherapy. As per outpatient discussion between \ndaughter and endocrinologist, it was thought that current \nsteroid dosing may be insufficient during off periods from \nchemo. Patient received IVF for 48 hrs. As per outpatient \nendocrinologist's discussion with daughter ___, I transitioned \nsteroid dosing to dexamethasone 2mg daily which patient \ntolerated well. As per endocrinologists recommendations she was \ninstructed to take 2mg daily but informed that she could split \nthe dosing into 1mg BID if she felt it was more successful in \ncontrolling malaise. She was continued on her normal dose of \nfludrocortisone.\n\n# Breast Cancer\n# Neutropenia\nPatient currently on neoadjuvant ddAC, with neutropenia as a \nresult of chemotherapy for which she received Neulasta OnPro. \nThroughout the course of her hospitalization her WBC improved \nslowly and she remained afebrile. At time of discharge her WBC \nwas 1.8K (51% PMN). Patient was instructed to f/u in ___ \nclinic on ___ to have her counts re-checked. \n\n# Anemia in malignancy\n# Thrombocytopenia\nPatient with profound new thrombocytopenia/anemia which is \nlikely ___ bone marrow suppression from cumulative chemotherapy \ndosing as retic count was low, haptoglobin normal, Fe studies \nwith high ferritin, low TIBC, coags wnl, smear without shistos. \nShe had ___ hx of bleeding/bruising or flank pain to suggest loss \nthrough bleeding either internal/external. However patient's \ndaughter felt that her abdomen was more bloated than usual so \nnon-con CT A/P ordered which did not reveal intra or \nretroperitoneal bleed. Patient was instructed to have her CBC \nre-checked at her next outpatient oncology followup appointment \nto ensure that she doesn't need a transfusion and that counts \nare rebounding appropriately. \n\nTransitional Issues:\n1. Patient is to have close outpatient f/u with her \nendocrinologist to trend her response to new dexamethasone \nregimen\n2. Patient is to have CBC checked at next outpatient oncology \nf/u apt on ___ to ensure that her platelets, WBC, and hemoglobin \nare rebounding. \n3. Patient found on CT to have a superficial, 8 mm round \nintermediate density lesion in the region of the right mons \npubis which was indeterminate, but may represent a sebaceous \ncyst. To be addressed/trended by dermatologist in outpatient \nsetting. Pt aware and in agreement with plan.", 'medications_prescribed': ['Dexamethasone 2 mg PO DAILY', 'Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB', 'Atorvastatin 20 mg PO DAILY', 'Calcitrate-Vitamin D (calcium citrate-vitamin D3) 315-250 \nmg-unit oral DAILY', 'Fludrocortisone Acetate 0.1 mg PO DAILY', 'Levothyroxine Sodium 88 mcg PO 6X/WEEK (___)', 'Levothyroxine Sodium 132 mcg PO 1X/WEEK (___)', 'Ondansetron 8 mg PO ASDIR', 'Prochlorperazine 10 mg PO Q6H:PRN nausea', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \ninhalation 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': 80, 'gender': 'F', 'symptoms': 'Left sided weakness', 'medical_history': ['-IDDM', '-Obesity', '-Diastolic Congestive heart failure', '-OSA on CPAP', '-Hypertension with microalbuminuria', '-Asthma', '-Hypothyroidism', '-Chornic low back pain, on narcotics'], 'family_history': 'Father with prostate cancer. She has 8 children, 1 of which has\nAIDS and another has diabetes. Daughter and son with asthma.', 'present_illness': 'HPI: \nMs. ___ is a ___ year-old right-handed ___ woman\nwith history of IDDM, HTN, CHF, Obesity, and OSA who presents\nwith left sided weakness and slurred speech noted at 6:30pm \nnight\nprior to presentation. \n\nShe was in her usual state of health until yesterday evening \nwhen\nshe had sudden onset left sided weakness. States that she was\nlaying in bed at the time because she took her nighttime\nmedications and was feeling somewhat sleepy. When she was \ntrying\nto get out of bed, she felt that her left arm was weak and she\nhad difficulty pushing herself up. When she finally stood up,\nshe thought that walking was a bit difficult as well as her \nwhole\nleft side felt weak. She uses a cane at baseline only when she\ngoes out of the house but last night she needed a cane in the\nhouse as well. \n\nHer sister, who lives with her, thought that her speech was\nslurred as well. She called her daughter at around 10pm. Her\ndaughter did not notice any slurred speech by that time. Pt\ndecided that she did not want to come to the hospital last night\nbecause she did not feel like waiting in the hospital. She went\nto bed.\n\nThis morning, her weakness is better but still present so she\npresented to ___ ED. She thinks that her speech is normal now. \n\n\nOf note, she had a FSS of 471 around 8pm last night for which \nshe\ntook insulin. FSS dropped to 125 after insulin.\n\nROS: Denies headache, loss of vision, blurred vision, diplopia,\ndysphagia, vertigo, tinnitus or hearing difficulty. Denies\ndifficulties comprehending speech. No recent change in bowel \nor\nbladder habits. ', 'medications': [{'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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 Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': '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': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, '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': '256', 'valuenum': 256.0, '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': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, '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': '273', 'valuenum': 273.0, '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': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, '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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 224.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '12', 'valuenum': 12.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '17', 'valuenum': 17.0, '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': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, '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': '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': 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': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, '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': '142', 'valuenum': 142.0, '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}], 'exams': "==============\nADMISSION EXAM\n==============\n\nPhysical Exam: \nVitals: T: 98.7 P: 80 BP: 179/92 RR: 16 O2sat: 96% \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, MMM, clear oropharynx \nNeck: Supple, no nuchal rigidity. \nPulmonary: Lungs CTA bilaterally \nCardiac: RRR\n\nNeurologic: \n-Mental Status: Alert, oriented x 3. Attentive. Able to relate\nhistory without difficulty. Language is fluent with intact\nrepetition and comprehension. Normal prosody. There were no\nparaphasic errors. Pt. was able to name both high and low\nfrequency objects. Able to read without difficulty. Speech was\nnot dysarthric. Able to follow both midline and appendicular\ncommands. She has good recall of recent events. There was no\nevidence of apraxia or neglect.\n\n-Cranial Nerves: \nI: Olfaction not tested. \nII: Right pupil oblong and left pupil 1mm. Both post-surgical\nand non-reactive. VFF to confrontation. \nIII, IV, VI: Decreased upgaze but otherwise EOMI. No nystagmus. \n\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 and has symmetric strengh.\n\n-Motor: Normal bulk, tone throughout. Pronator drift on the \nleft.\nNo adventitious movements. \n\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* Limited by back/hip pain\n\n-Sensory: Decreased pinprick and cold sensation in the left arm. \n\nLT intact throughout. Agraphesthesia in the left hand. No\nextinction to DSS.\n\n-DTRs: \n Bi Tri ___ Pat Ach \nL 2 2 2 2 1 \nR 2 2 2 2 1\nPlantar response was withdrawal bilaterally.\n\n-Coordination: No dysmetria on FNF or touching of the toes to \nthe\nexaminer's thumb bilaterally.\n\n-Gait: Had to use her arms to push herself up to sitting and\nstanding. States she feels weak. She was able to stand up\nwithout support. Romberg was negative. Defers further gait\nexam.", 'diagnoses': [{'icd_code': '85221', 'desc': 'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': '3492', 'desc': 'Disorders of meninges, not elsewhere classified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '71941', 'desc': 'Pain in joint, shoulder region'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '78702', 'desc': 'Nausea alone'}, {'icd_code': '2989', 'desc': 'Unspecified psychosis'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': 'E8889'}], 'summary': "==============\nADMISSION LABS\n==============\n\n___ 01:30PM BLOOD WBC-7.5 RBC-4.38 Hgb-13.3 Hct-39.9 MCV-91 \nMCH-30.3 MCHC-33.2 RDW-13.5 Plt ___\n___ 01:30PM BLOOD Neuts-65.5 ___ Monos-5.2 Eos-3.9 \nBaso-0.4\n___ 01:30PM BLOOD ___ PTT-28.6 ___\n___ 01:30PM BLOOD Plt ___\n___ 01:30PM BLOOD Glucose-142* UreaN-14 Creat-0.6 Na-142 \nK-4.0 Cl-105 HCO3-28 AnGap-13\n___ 07:10PM BLOOD ALT-12 AST-22 LD(LDH)-212 CK(CPK)-116 \nAlkPhos-113* TotBili-0.2\n___ 01:30PM BLOOD cTropnT-<0.01\n___ 07:10PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 01:30PM BLOOD Calcium-8.7 Phos-3.2 Mg-1.9\n___ 07:10PM BLOOD TSH-4.2\n___ 07:10PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\n==============\nPERTINENT LABS\n==============\n\n___ 05:55AM BLOOD %HbA1c-7.4* eAG-166*\n___ 05:55AM BLOOD Triglyc-90 HDL-30 CHOL/HD-3.9 LDLcalc-68\n___ 07:10PM BLOOD TSH-4.2\n\n==============\nDISCHARGE LABS\n==============\n\n___ 05:33AM BLOOD WBC-7.8 RBC-4.26 Hgb-12.7 Hct-39.5 MCV-93 \nMCH-29.8 MCHC-32.2 RDW-13.6 Plt ___\n___ 05:33AM BLOOD Glucose-95 UreaN-22* Creat-0.9 Na-140 \nK-4.8 Cl-101 HCO3-33* AnGap-11\nHOSPITAL COURSE: Ms. ___ is ___ year-old right-handed woman \nwith a history of insulin-dependent diabetes (with retinopathy), \nhypertension (with microalbuminuria), diastolic congestive heart \nfailure, obesity, and obstructive sleep apnea (on CPAP), who \npresents with left sided weakness and possible neglect. MRI \nshowed multiple acute and subacute infarcts of the right coronal \nradiata, insula and superior temporal lobes. These findings are \nconsistent with embolic or thromboembolic event with right MCA \ndistribution of emboli leading to several infarcts. Potential \netiologies include cardioembolism or carotid thromboembolism. \nCerebrovascular visualization on the MRA was suboptimal. CTA \nHead/Neck showed some atherosclerosis but no stenosis. Pt was \nmonitored on telemetry, which showed no atrial fibrillation. A \ntransesophageal cardiac echo was done (recent transthoracic \ncardiac echo was equivocal due to body habitus), which showed \npossible PFO but no cardiac thrombus, normal EF, mild-moderate \nAR and no vegatations on AV, and simple plaque in the aortic \narch and descending aorta. \n\nThe etiology of the stroke appears to be embolic but the source \nof embolism remains unclear. Although the patient has a possible \nPFO, there was no clinical suspicion of DVT during admission, \nand this will be further worked up by the PCP and ___ \nas an outpatient, if indicated.\n\n- Pt's LDL was 68. Was discharged on Plavix 75 mg and no ASA, \nand atorvastatin 20.\n- Pt was kept on insulin regimen plus Humalog at mealtimes, with \ndoses increased this admission. Kept on diabetic diet. HbA1c was \n7.4."}}
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{'final_diagnoses': ['Acute ischemic strokes of the right coronal radiata, insula and \nsuperior temporal lobes'], 'procedures': ['None'], 'visit_summary': "HOSPITAL COURSE: Ms. ___ is ___ year-old right-handed woman \nwith a history of insulin-dependent diabetes (with retinopathy), \nhypertension (with microalbuminuria), diastolic congestive heart \nfailure, obesity, and obstructive sleep apnea (on CPAP), who \npresents with left sided weakness and possible neglect. MRI \nshowed multiple acute and subacute infarcts of the right coronal \nradiata, insula and superior temporal lobes. These findings are \nconsistent with embolic or thromboembolic event with right MCA \ndistribution of emboli leading to several infarcts. Potential \netiologies include cardioembolism or carotid thromboembolism. \nCerebrovascular visualization on the MRA was suboptimal. CTA \nHead/Neck showed some atherosclerosis but no stenosis. Pt was \nmonitored on telemetry, which showed no atrial fibrillation. A \ntransesophageal cardiac echo was done (recent transthoracic \ncardiac echo was equivocal due to body habitus), which showed \npossible PFO but no cardiac thrombus, normal EF, mild-moderate \nAR and no vegatations on AV, and simple plaque in the aortic \narch and descending aorta. \n\nThe etiology of the stroke appears to be embolic but the source \nof embolism remains unclear. Although the patient has a possible \nPFO, there was no clinical suspicion of DVT during admission, \nand this will be further worked up by the PCP and ___ \nas an outpatient, if indicated.\n\n- Pt's LDL was 68. Was discharged on Plavix 75 mg and no ASA, \nand atorvastatin 20.\n- Pt was kept on insulin regimen plus Humalog at mealtimes, with \ndoses increased this admission. Kept on diabetic diet. HbA1c was \n7.4.", 'medications_prescribed': ['1. Atenolol 100 mg PO DAILY', '2. Docusate Sodium 100 mg PO BID', '3. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID', '4. Furosemide 80 mg PO DAILY', '5. Lactulose 15 mL PO DAILY:PRN Constipation', '6. Levothyroxine Sodium 100 mcg PO DAILY', '7. Omeprazole 20 mg PO BID', '8. OxycoDONE (Immediate Release) 10 mg PO BID:PRN low back pain', '9. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation \nq4hr wheezing', '10. Senna 8.6 mg PO BID:PRN constipation', '11. liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous daily', '12. MetFORMIN (Glucophage) 1000 mg PO BID', '13. NIFEdipine CR 60 mg PO DAILY', '14. Valsartan 320 mg PO DAILY', '15. Atorvastatin 20 mg PO DAILY', '16. Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*90 \nTablet Refills:*3', '17. Glargine 80 Units Breakfast\nHumalog 15 Units Breakfast\nHumalog 10 Units Lunch\nHumalog 20 Units Dinner\nInsulin SC Sliding Scale using REG Insulin']}
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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': 'Chest Pain', 'medical_history': ['# HTN', '# HL', '# GERD', '# ___ ___ volume depletion', '# DJD', '# Anxiety/Depression', '# Severe osteoarthritis', '# Migraines/Headaches', '# UTI on ___ with Pan-sensitive E.Coli', '# Right Wrist Colles Fracture: Admitted ___ - ___ ___.'], 'family_history': 'Non-contributory to PEs', 'present_illness': "___ HTN and mild dementia presented to ___ ___. At the \ntime she complained of acute onset of left sided chest pain with \nradiation to her left shoulder. Pt was ruled out for MI, CTA \nrevealed bilateral PE's and a concernening left upper lobe lung \nmass. Initiated daily dosing lovenox. Also during her \nhosptialization she complained of RUQ pain (LFTs WNL) that \nresolved. The pt also received a dose of Levofloxacin for \nunclear reasons on ___. \n. \nOn transfer was asymptomatic. Family requested transfer to ___ as \npt's PCP affiliated with ___ and family based in ___. Vitals \nprior to transfer were 98.1, 132/61, 84, 20, SaO2 90-93/2 L. \nThis was a new )2 requirement. Overnight at ___ she remained \nhemodyanamically stable and her Lovenox dosing was adjusted to \n1mg/kg BID. Her HCP was called and updated of her transfer.", 'medications': [{'medication': 'Tolterodine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', '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': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BusPIRone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Neomycin-Polymyxin B GU', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IR', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'BusPIRone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', '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': 'Ferrous Sulfate', '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': 'Lidocaine Jelly 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', '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': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, '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': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.3', 'valuenum': 50.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '356', 'valuenum': 356.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '340', 'valuenum': 340.0, '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': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Exam:\nVS: 97 124/71 87 15 99% on 2L nc \nGENERAL: Well-appearing F in NAD, sleeping comfortably, \nHEENT: NC/AT, PERRLA, sclerae anicteric, very dry \nNECK: Supple \nHEART: regular rate, no MRG, nl S1-S2. No loud P2 or S3. \nLUNGS: CTA bilat \nABDOMEN: obese, soft, NABS, mild TTP throughout, distended \nEXTREMITIES: Cast on right arm. WWP, no c/c/e, 2+ peripheral \npulses. \nSKIN: No rashes or lesions. \nNEURO: alert, no focal deficits \n.\nDischarge Exam: \nAVSS. 97% on 2L\nMild RUQ Tenderness. No abdominal distension.\nPhysical Exam unchanged.', 'diagnoses': [{'icd_code': '9975', 'desc': 'Urinary complications, not elsewhere classified'}, {'icd_code': '74100', 'desc': 'Spina bifida with hydrocephalus, unspecified region'}, {'icd_code': '56481', 'desc': 'Neurogenic bowel'}, {'icd_code': 'E8783', 'desc': 'Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '59654', 'desc': 'Neurogenic bladder NOS'}, {'icd_code': '29680', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': '55320', 'desc': 'Ventral, unspecified, hernia without mention of obstruction or gangrene'}, {'icd_code': '319', 'desc': 'Unspecified intellectual disabilities'}, {'icd_code': '78930', 'desc': 'Abdominal or pelvic swelling, mass, or lump, unspecified site'}, {'icd_code': 'V452'}], 'summary': 'Admission Labs\n___ 06:50AM BLOOD WBC-18.6*# RBC-3.61* Hgb-10.6* Hct-31.8* \nMCV-88 MCH-29.3 MCHC-33.2 RDW-13.3 Plt ___\n___ 06:30AM BLOOD ___ PTT-37.0* ___\n___ 06:50AM BLOOD Glucose-116* UreaN-22* Creat-0.9 Na-139 \nK-4.2 Cl-102 HCO3-25 AnGap-16\n___ 06:50AM BLOOD Calcium-8.6 Phos-4.6* Mg-2.2\n.\nDischarge Labs\n___ 05:48AM BLOOD WBC-14.1* RBC-3.64* Hgb-10.7* Hct-32.7* \nMCV-90 MCH-29.4 MCHC-32.7 RDW-13.4 Plt ___\n___ 05:48AM BLOOD ___\n___ 05:48AM BLOOD Glucose-91 UreaN-18 Creat-0.8 Na-142 \nK-4.0 Cl-105 HCO3-23 AnGap-18\n___ 05:58AM BLOOD ALT-7 AST-15 AlkPhos-98 TotBili-0.3\n.\nRUQ U/S:\nDifficult study due to the patient\'s body habitus and difficulty \nwith breath holding. The liver is incompletely visualized but \nnormal in echotexture. There is a large gallstone in the \ngallbladder, which is otherwise unremarkable in appearance. The \ncommon duct is not dilated. No free fluid in the right upper \nquadrant. The portal vein is patent with normal hepatopetal \nflow. \nIMPRESSION: Large gallstone within an otherwise normal \ngallbladder. \n.\nCT L-Spine\nINDICATION: Acute PE, possible left upper lobe mass, with \nurinary retention and lower extremity instability. (Inability to \ntolerate MR.) \nCOMPARISON: CT abdomen and pelvis from ___. \nTECHNIQUE: Helical axial MDCT-acquired images of the lumbar \nspine were \nobtained without administration of intravenous contrast. Coronal \nand sagittal reformatted images were reviewed. \nFINDINGS \nThere are multilevel degenerative changes throughout the lumbar \nspine, without osseous lesion concerning for malignancy. There \nis no concerning epidural or paraspinal soft tissue mass. \n\nAt L3-L4, there is posterior disc bulge with moderate spinal \ncanal stenosis. There is mild bilateral neural foraminal \nnarrowing, more prominent on the left. \n\nAt L4-L5, there is Grade 1 anterolisthesis of L4 on L5, similar \nin appearance from prior study of ___, with disc \ndegeneration and vacuum phenomenon and posterior disc bulge, \nresulting in severe central canal stenosis. There is severe \nright neural foraminal narrowing with encroachment upon the \nexiting right L4 nerve root. There is moderate left neural \nforaminal narrowing. \n \nAt L5-S1, there is posterior disc bulge, ligamentum flavum \nthickening and \nfacet hypertrophy with resultant moderate spinal canal stenosis. \nThere is no significant neural foraminal narrowing. \n \nPartially visualized abdominal viscera demonstrate a 2.7 x 2.1 \ncm left adrenal mass (60 ___ which appears smaller when compared \nto prior (non-enhanced) study of ___ when it measured 3.2 x \n1.9 cm, and only 5 ___, and likely represents a lipid-rich \nadrenal adenoma. The limbs of the right adrenal gland appear \nthickened, with a 1.4-cm right lesion at its crus, which was not \nappreciated on prior study; this may represent additional \nadenoma, in the setting of hyperplasia, though a metastatic \nlesion cannot be excluded. \n \nA 5.5-cm gallstone is again noted in a nondistended gallbladder. \n \n \nA 1.3 x 1.6 cm hypodense renal lesion is again noted, similar in \nsize and \nappearance from prior study. There is diffuse calcified \natherosclerosis \ninvolving the abdominal aorta and its major branches, without \nsignificant \nstenosis or aneurysm formation. \n \nIMPRESSION: \n1. No concerning osseous or soft tissue lesion. \n2. Multilevel degenerative changes throughout the lumbar spine, \nsimilar in \nappearance from the study dated ___, with spinal canal and \nsevere right neural foraminal stenosis at the L4-L5 level. \n3. 2.7-cm left adrenal lesion is slightly smaller than prior \nstudy and likely represents an adrenal adenoma, based on its \nshrinkage and prior imaging characteristics. A 1.4-cm right \nadrenal lesion was not appreciated on the prior study and \ncannot be fully characterized in this enhanced study: this may \nrepresent adrenal adenoma but metastatic lesion cannot be \nexcluded. \n \n4. Cholelithiasis without evidence of cholecystitis. \n \nCOMMENT: If there is continued clinical concern for "cauda \nequina syndrome," further evaluation with enhanced MRI should be \nconsidered (if feasible). \n.\nCT Head:\nINDICATION: Progressive confusion with suspected left upper lobe \nmass. \nBilateral pulmonary embolism documented at outside hospital. \n \nCOMPARISON: CT head, ___. \n \nTECHNIQUE: Contiguous axial MDCT-acquired images through the \nhead were \nobtained after uneventful administration of intravenous \ncontrast. \n \nFINDINGS: A 2.0 x 1.6 cm well-demarcated and avidly-enhancing \n(75HU) lesion \nat the level of the right cerebellar hemisphere (2:7) likely \nrepresents an \nincidental meningioma of tentorial origin. There is bony \nremodeling with \nscalloping of the suprajacent inner table of the skull, similar \nin appearance \nfrom prior study dated ___. There is no other concerning \nextra- or \nintra-axial focus of enhancement. \n \nThe gray-white matter differentiation is well-preserved. \n \nThe ventricles and sulci are prominent in size and configuration \ncompatible \nwith age-related global parenchymal atrophy. Periventricular \nwhite matter \nhypodensities are likely due to chronic small vessel ischemic \ndisease. \n \nBone windows (2.5 mm section thickness images) demonstrate no \nosseous lesion \nconcerning for malignancy. \n \nThere is mild mucosal thickening within the maxillary sinuses \nand right \nmastoid air cells. The remaining visualized paranasal sinuses \nand left mastoid \nair cells are clear. \n \nIMPRESSION: \n1. No finding to suggest parenchymal metastasis. \n2. 2.0 cm well-demarcated enhancing lesion with adjacent \nscalloped skull \nlikely represents an incidental tentorial meningioma; given its \nappearance and \nstability, dural-based metastasis is significantly less likely\n___ HTN and mild dementia Hospital that presented from an OSH \nwith submassive PE and leukocytosis, and was ruled out for upper \nlobe mass and infectious etiologies \n.'}}
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{'final_diagnoses': ['Pulmonary Embolism (Submassive)', 'Urinary Retention', 'Cholelithiasis', 'Dementia'], 'procedures': ['None'], 'visit_summary': '___ HTN and mild dementia Hospital that presented from an OSH \nwith submassive PE and leukocytosis, and was ruled out for upper \nlobe mass and infectious etiologies \n.', 'medications_prescribed': ['Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day: \nPlease titrate Coumadin to INR of goal of ___.', 'enoxaparin 100 mg/mL Syringe Sig: One (1) Subcutaneous Q12H \n(every 12 hours): Please continue until 48hrs after pt has \nmaintained an INR of ___. Then discontinue. ', 'nifedipine 90 mg Tablet Extended Release Sig: One (1) Tablet \nExtended Release PO DAILY (Daily). ', 'meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', 'aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', 'acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours). ', 'senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', 'pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO once a day. ', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', 'calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One \n(1) Tablet, Chewable PO TID (3 times a day). ', 'cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily). ', 'multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', 'doxazosin 1 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime). ', 'pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', 'magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO Q6H (every 6 hours) as needed for gerd. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 53, 'gender': 'M', 'symptoms': 'confusion', 'medical_history': ['Depression', 'hypertension', 'CHF', 'GERD', 'history of atrial \nfibrillation and DVT', 'history of fibromyalgia', 'hx breast cancer', '? presence of renal mass.'], 'family_history': 'three siblings with Dm, sister with ___, siblings with CAD', 'present_illness': '___ yo F c/PMhx of Afib (on coumadin), h/o remote DVT, CHF p/w \nmultiple problems, including worsening confusion x 1 week, 2 \nfalls, worsening leg swelling, and decreased mobility who was \nfound in the ED to have a supratherapeutic INR and and elevated \nHR to the 140s consistent with Afib with RVR. Family reports \nthat one week ago pt started getting more confused and had a \nvery bad day on ___ where she reportedly forgot her son had \nvisited, was using made-up words, and was having hallucinations. \nPt denies CP, SOB, palpitations, dizziness, cough, fevers and \nchills. Pt reports some constipation x 3 days, but denies \nabdominal pain. Pt also notes her leg swelling has not improved \ndespite increasing lasix dose. Continues to report heel pain at \narea of cellulitis, ___, sharp with ambulation or pressure. She \ndoes have some nausea, but not vomiting. Pt also reports some \nurinary urgency, but denies hematuria or dysuria.\n.\nPer SNF notes, INR was 3.4 on ___ and coumadin has been held \nsince. Pt was also on Bactrim DS (finished ___ for cellulitis \nof left heel. Neurontin on hold for questiong worsening \ninstability. Tachy to 113-120 on ___.\n.\nROS was otherwise essentially negative except as documented \nabove. The pt denied recent unintended weight loss, fevers, \nnight sweats, chills, headaches, dizziness or vertigo, changes \nin hearing or vision, including amaurosis fugax, neck stiffness, \nlymphadenopathy, hematemesis, coffee-ground emesis, dysphagia, \nodynophagia, heartburn, nausea, vomiting, diarrhea, \nconstipation, steatorrhea, melena, hematochezia, cough, \nhemoptysis, wheezing, shortness of breath, chest pain, \npalpitations, dyspnea on exertion, increasing lower extremity \nswelling, orthpnea, paroxysmal nocturnal dyspnea, leg pain while \nwalking, joint pain.', 'medications': [{'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydroxyurea', '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': 'Inactive (Due to a change order)', 'route': 'IV', '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': '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': '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': '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H: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': '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': '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': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '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': '89', 'valuenum': 89.0, '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': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '___', 'valuenum': 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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': '<5*.'}, {'value': '612', 'valuenum': 612.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '3+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '8.0', 'valuenum': 8.0, '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': '2+.'}, {'value': '58', 'valuenum': 58.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': 'NORMAL.'}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.16', 'valuenum': 2.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 0.5, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '80', 'valuenum': 80.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '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': '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': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, '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': '37.2', 'valuenum': 37.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, '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': '19.6', 'valuenum': 19.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.93', 'valuenum': 1.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '3 NRBCS/100 WBCS SEEN.'}, {'value': '23.1', 'valuenum': 23.1, '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}], 'exams': 'Vitals: T: 99.5 BP: 133/64 P: 84 R: 18 SaO2: 100%RA\nGeneral: Awake, alert, NAD, pleasant, appropriate, cooperative.\nHEENT: NCAT, PERRL, EOMI, no scleral icterus, MMM, no lesions \nnoted in OP\nNeck: supple, JVD just above clavicles with HOB at 30 degress, \nno carotid bruits appreciated\nPulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales\nCardiac: RR, nl S1 S2, ___ SEM at LUSB, no rubs or gallops \nappreciated\nAbdomen: soft, NT, ND, normoactive bowel sounds, no masses or \norganomegaly noted\nExtremities: 3+ nonpitting gross ___ edema with chronic venous \nstasis changes, 2x3 cm necrotic lesion at left heel without \ndrainage, erythema, bony or muscle protrusions, 2+ radial, DP \npulses b/l, sensation intact to gross touch\nNeurologic: Alert, oriented x 3. Unable to spell world \nbackwards. recalls ___ words at 5 minutes. Cranial nerves II-XII \nintact. ___ UE and ___ strength BILATERALLY. No abnormal \nmovements noted. No deficits to light touch throughout.', 'diagnoses': [{'icd_code': '28262', 'desc': 'Hb-SS disease with crisis'}, {'icd_code': '2866', 'desc': 'Defibrination syndrome'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '30400', 'desc': 'Opioid type dependence, unspecified'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': '2819', 'desc': 'Unspecified deficiency anemia'}, {'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}, {'icd_code': 'V180'}], 'summary': '======= \nLabs\n=======\n\n___ 07:00AM BLOOD WBC-3.3* RBC-3.06* Hgb-8.7* Hct-26.0* \nMCV-85 MCH-28.4 MCHC-33.5 RDW-14.1 Plt ___\n___ 06:25AM BLOOD WBC-3.9* RBC-3.03* Hgb-8.8* Hct-25.5* \nMCV-84 MCH-28.9 MCHC-34.4 RDW-14.6 Plt ___\n___ 01:22PM BLOOD WBC-4.2 RBC-3.24* Hgb-9.6* Hct-26.8* \nMCV-83 MCH-29.6 MCHC-35.8* RDW-14.8 Plt ___\n___ 07:00AM BLOOD ___ PTT-34.1 ___\n___ 06:25AM BLOOD ___ PTT-38.2* ___\n___ 01:22PM BLOOD ___ PTT-36.1* ___\n___ 07:00AM BLOOD Glucose-90 UreaN-18 Creat-1.5* Na-136 \nK-3.8 Cl-96 HCO3-35* AnGap-9\n___ 06:25AM BLOOD Glucose-89 UreaN-22* Creat-1.8* Na-137 \nK-3.6 Cl-95* HCO3-36* AnGap-10\n___ 01:22PM BLOOD Glucose-112* UreaN-28* Creat-2.2* Na-136 \nK-3.8 Cl-94* HCO3-34* AnGap-12\n___ 06:25AM BLOOD ALT-7 AST-20 CK(CPK)-90 AlkPhos-61 \nTotBili-0.3\n___ 06:25AM BLOOD CK-MB-NotDone cTropnT-0.03*\n___ 09:00PM BLOOD CK-MB-4 cTropnT-0.03*\n___ 01:22PM BLOOD CK-MB-4 cTropnT-0.04*\n___ 06:25AM BLOOD calTIBC-342 Ferritn-18 TRF-263\n___ 06:25AM BLOOD TSH-1.7\n\n=======\nMicro\n=======\nblood cx ngtd x 2\nurine cx negative\n\n___ 6:55 pm SWAB Source: left heel. \n\n=======\nRadiology\n=======\nCXR ___ - AP PORTABLE UPRIGHT CHEST, ONE VIEW: Heart is in \nupper limits of normal in size. Otherwise, cardiomediastinal \ncontours are unremarkable. There is increased interstitial \nmarkings bilaterally, suggestive of mild fluid overload. No \nfocal pneumonic consolidation is identified. There is no\npleural effusion or pneumothorax.\nIMPRESSION: Mild fluid overload.\n\nCT Head ___. Age-related involutional changes and \nperiventricular white matter chronic ischemic changes.\n2. No areas of hemorrhage or acute infarction.\n\nCT Head ___ - IMPRESSION: No acute intracranial hemorrhage \nseen. No fracture. New scalp swelling from hematoma overlying \nleft frontal bone.\n\nHip XR ___- Seven radiographs of the pelvis and bilateral hips \nare submitted. No fracture. Femoral head contours are smooth. \nAssessment of the sacrum is limited by overlying bowel gas. \nPhleboliths project over the pelvis. Symphysis pubis is \nunremarkable.\n\nHeel XR ___ - Lateral and axial views of the left os calcis \nshow no fracture or bone destruction. Posterior and plantar \ncalcaneal spurs. No discrete soft tissue ulceration identified. \nVascular calcifications.\n\n=======\nCardiology\n=======\nECG ___ - Baseline artifact. Atrial fibrillation with rapid \nventricular response. Low limb lead voltage. Late R wave \nprogression. Leftward axis. No previous tracing available for \ncomparison. Clinical correlation is suggested.\n\nTTE ___ - Conclusions\nThe left atrium is mildly dilated. The right atrium is \nmoderately dilated. There is mild symmetric left ventricular \nhypertrophy with normal cavity size. Regional left ventricular \nwall motion is normal. Overall left ventricular systolic \nfunction is normal (LVEF>55%). Tissue Doppler imaging suggests \nan increased left ventricular filling pressure (PCWP>18mmHg). \nRight ventricular chamber size and free wall motion are normal. \nThere are three aortic valve leaflets. The aortic valve leaflets \nare moderately thickened. There is a minimally increased \ngradient consistent with minimal aortic valve stenosis. No \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. There is \nmoderate thickening of the mitral valve chordae. Mild (1+) \nmitral regurgitation is seen. There is borderline pulmonary \nartery systolic hypertension. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \npreserved global and regional biventricular systolic function. \nElevated left ventricular filling pressure. Minimal aortic \nstenosis. Mild mitral regurgitation. Borderline pulmonary \nhypertension. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n 4+ (>10 per 1000X FIELD): GRAM POSITIVE ROD(S).\n## Acute on chronic renal failure / ___ swelling: Pt was admitted \nwith Cr of 2.2 abover her baseline of 1.3. Cr improved with \nLasix. Urine eos positive. Etiology likely ___ to decreased \nrenal perfusion in the setting of volume overload and AIN from \nbactrim (prescribed prior to admission for cellulitis). TTE \nnegative for systolic failure, and pulmonary exam improved with \ndiuresis. ARF is likely contributing to worsening leg swelling \nin setting of chronic venous stasis. Transitioned to Lasix 80 mg \npo BID as new home regimen dose.\n.\n## Cellulitis: Lesion on LEFT heel appears necrotic, but dry and \nnot infected. Pt completed 5 d. course of bactrim prior to \nadmission. Does not appear systemically infected. Heel xr \nsuggests no bony involvement. Podiatry consult requested and \nfelt ulcer consistent with pressure ulcer and did not need \nfurther treatment or debirdement. Wound cx grew GPRs, but \npodiatry felt this was likely a contaminant and decided not to \npursue further antibx intervention. \n.\n## Falls/Weakness: Patient hx of falls are decidedly not \nsyncopal in nature and appear to be secondary to poor \nconditioning. TTE showed minimal AS, and not consistent with \nfailure. Pt had a fall in house while transferring from \nstretcher to the bed coming back from TTE. CT head and hip plain \nfilms were negative. Negative neuro exam. Head Ct negative for \nacute intracranial bleed and hip films negative for acute \nfracture. Overall, falls likely ___ deconitioning.\n.\n## A fib with RVR and supratherapeutic INR: In the ED, patient \nhad afib with RVR. Patient was rate controlled on the floor once \nher at home medications were restrated. Unclear why patient \npresented with worsening Afib despite two rate controlling \nagents. TSH normal, ___ complete and CXR without infiltrate. No \nhx of medicine non-compliance, but pt did not receive \nmedications until late on the day of admission. Supratherapetic \nINR improved, and was likely ___ to bactrim use. Plan to restart \ncoumadin on ___ at previous dose with INR checked in ___ days \nfor dose adjustment. \n.\n## Change in Mental Status: Mental status was clear during this \nhospital stay, and pt remained A and Ox3. Pt hx consistent with \nacute delerium over the weekend prior to admission. Likely \nrelated to worsening renal function, and high dose narcotics for \nchronic pain. Afebrile, no leukocytosis, UA negative and CXR \nwithout infiltrate, so unlikely to be sepsis. Family feels that \nNeurontin may have been responsible for cognitive decline, and \nthis has been held for 4 days (see below for pain regimen).\n.\n## Anemia: Hct stable. Unknown baseline. Iron studies \nnon-specific \n.\n## Renal mass: Per pt, there is a hx of a renal mass that may or \nmay not be RCC. Notes were obtained from outside hospital \nrecords. This mass has been worked up at ___ \n___ by Urology and Oncology, and medical team there has \ndecided along with family that this is likely a slow growing \ntumor that should probably only be watched, rather than treated. \nRisks of nephrectomy appear to outweigh benefits in this patient \nwith multiple medical comorbidities.\n.\n## HTN: Continued lopressor, diltiazem\n.\n## Chronic pain: Stopped methadone in setting of ARF. Continue \ntylenol and morphine 7.5 for breakthrough. Patient wad \ndischraged on Morphine Sustained release 15 mg po BID and 7.5 mg \npo q8 for breakthrough pain. \n.\n## Depression: Continued SSRI, lorazepam\n.\n## Nausea: Continued promethazine prn\n.\n## Access: pivs\n.\n## FEN/Lytes: Cardiac diet, replete lytes prn\n.\n## Prophylaxis: supertherapeutic INR, ppi, bowel regimen\n.\n## Code status: DNR/DNI (confrimed with pt and son)\n.\n## Communication: ___ (son) ___'}}
|
{'final_diagnoses': ['Atrial fibrillation', 'Depression', 'hypertension', 'CHF', 'GERD', 'history of \natrial fibrillation and DVT', 'history of fibromyalgia', 'hx breast \ncancer', '? presence of renal mass.'], 'procedures': ['none'], 'visit_summary': '## Acute on chronic renal failure / ___ swelling: Pt was admitted \nwith Cr of 2.2 abover her baseline of 1.3. Cr improved with \nLasix. Urine eos positive. Etiology likely ___ to decreased \nrenal perfusion in the setting of volume overload and AIN from \nbactrim (prescribed prior to admission for cellulitis). TTE \nnegative for systolic failure, and pulmonary exam improved with \ndiuresis. ARF is likely contributing to worsening leg swelling \nin setting of chronic venous stasis. Transitioned to Lasix 80 mg \npo BID as new home regimen dose.\n.\n## Cellulitis: Lesion on LEFT heel appears necrotic, but dry and \nnot infected. Pt completed 5 d. course of bactrim prior to \nadmission. Does not appear systemically infected. Heel xr \nsuggests no bony involvement. Podiatry consult requested and \nfelt ulcer consistent with pressure ulcer and did not need \nfurther treatment or debirdement. Wound cx grew GPRs, but \npodiatry felt this was likely a contaminant and decided not to \npursue further antibx intervention. \n.\n## Falls/Weakness: Patient hx of falls are decidedly not \nsyncopal in nature and appear to be secondary to poor \nconditioning. TTE showed minimal AS, and not consistent with \nfailure. Pt had a fall in house while transferring from \nstretcher to the bed coming back from TTE. CT head and hip plain \nfilms were negative. Negative neuro exam. Head Ct negative for \nacute intracranial bleed and hip films negative for acute \nfracture. Overall, falls likely ___ deconitioning.\n.\n## A fib with RVR and supratherapeutic INR: In the ED, patient \nhad afib with RVR. Patient was rate controlled on the floor once \nher at home medications were restrated. Unclear why patient \npresented with worsening Afib despite two rate controlling \nagents. TSH normal, ___ complete and CXR without infiltrate. No \nhx of medicine non-compliance, but pt did not receive \nmedications until late on the day of admission. Supratherapetic \nINR improved, and was likely ___ to bactrim use. Plan to restart \ncoumadin on ___ at previous dose with INR checked in ___ days \nfor dose adjustment. \n.\n## Change in Mental Status: Mental status was clear during this \nhospital stay, and pt remained A and Ox3. Pt hx consistent with \nacute delerium over the weekend prior to admission. Likely \nrelated to worsening renal function, and high dose narcotics for \nchronic pain. Afebrile, no leukocytosis, UA negative and CXR \nwithout infiltrate, so unlikely to be sepsis. Family feels that \nNeurontin may have been responsible for cognitive decline, and \nthis has been held for 4 days (see below for pain regimen).\n.\n## Anemia: Hct stable. Unknown baseline. Iron studies \nnon-specific \n.\n## Renal mass: Per pt, there is a hx of a renal mass that may or \nmay not be RCC. Notes were obtained from outside hospital \nrecords. This mass has been worked up at ___ \n___ by Urology and Oncology, and medical team there has \ndecided along with family that this is likely a slow growing \ntumor that should probably only be watched, rather than treated. \nRisks of nephrectomy appear to outweigh benefits in this patient \nwith multiple medical comorbidities.\n.\n## HTN: Continued lopressor, diltiazem\n.\n## Chronic pain: Stopped methadone in setting of ARF. Continue \ntylenol and morphine 7.5 for breakthrough. Patient wad \ndischraged on Morphine Sustained release 15 mg po BID and 7.5 mg \npo q8 for breakthrough pain. \n.\n## Depression: Continued SSRI, lorazepam\n.\n## Nausea: Continued promethazine prn\n.\n## Access: pivs\n.\n## FEN/Lytes: Cardiac diet, replete lytes prn\n.\n## Prophylaxis: supertherapeutic INR, ppi, bowel regimen\n.\n## Code status: DNR/DNI (confrimed with pt and son)\n.\n## Communication: ___ (son) ___', 'medications_prescribed': ['Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO four times \na day.\nDisp:*120 Tablet(s)* Refills:*2*', 'Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) as needed.\nDisp:*30 Tablet(s)* Refills:*0*', 'Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*', 'Promethazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for nausea.\nDisp:*30 Tablet(s)* Refills:*0*', 'Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) \nas needed for constipation.\nDisp:*30 Tablet(s)* Refills:*2*', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) as needed.\nDisp:*30 Capsule(s)* Refills:*0*', 'Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H \n(every 6 hours).\nDisp:*240 Tablet(s)* Refills:*2*', 'Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID \n(3 times a day).\nDisp:*1 bottle* Refills:*2*', 'Collagenase 250 unit/g Ointment Sig: One (1) Appl Topical \nDAILY (Daily).\nDisp:*1 tube* Refills:*2*', 'Furosemide 80 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).\nDisp:*60 Tablet(s)* Refills:*2*', 'Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO twice a day: Please hold for lethargy, \ndecreased mental status, decresed respiratory rate, or \nconstipation.\nDisp:*60 Tablet Sustained Release(s)* Refills:*0*', 'Morphine 15 mg Tablet Sig: ___ Tablet PO every eight (8) \nhours as needed for pain: Please administer as a prn for \nbreakthrough after morphine extended release has been given.\nDisp:*30 Tablet(s)* Refills:*0*', 'Warfarin 1 mg Tablet Sig: 1.5 Tablets PO once a day: Please \nstart again on ___. Please adjust according to INR.\nDisp:*45 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': 46, 'gender': 'M', 'symptoms': 'sent to ER for low WBC', 'medical_history': ['Status post appendectomy in second grade.', 'Graves disease.'], 'family_history': 'no history of thyroid disease in the family', 'present_illness': "___ female recently diagnosed with Grave's disease and started \non methimazole, who developed pancytopenia likely secondary to \nmethimazole. Off methimazole since ___. Recent \nhospitalization at ___ for staph pharyngitis in \nsetting of neutropenia, was treated with neupogen and augmentin. \nLast abx dose 5 days ago, patient has been afebrile since that \ntime. Sore throat resolved. Noted to have decreasing WBC again \non labs, last WBC count 2.0 2 days ago on ___. Referred in \nby endocrinologist (Dr. ___ \n___) for further eval as again neutropenic at \n___. Scheduled for thyroidectomy ___. \n\nThe patient was noted to be bacteremic with MSSA at ___ and was \non IV abx from ___ upon discharge, she was treated with an \nadditional 4 days of Augmentin for this as well as her \npharyngitis.\n\nCurrently she feels well without fever, chills, nausea, \nvomiting. She has had a 40 pound weight loss x 6 months. Eye \ndryness/gritiness but no blurred vision or changes to her eyes \nsubjectively. No SOB, some DOE, no orthopnea or CP. + Fatigue. \n No diarrhea, some mild constipation since starting iron \nsupplement. Rest of systems is negative.", 'medications': [{'medication': 'Cisatracurium Besylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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', '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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Acetaminophen', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Cisatracurium Besylate', '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': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'GuaiFENesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', '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': '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins W/minerals Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Terazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'MetroNIDAZOLE', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '-14', 'valuenum': -14.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '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': '54', 'valuenum': 54.0, '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': '___', 'valuenum': 7.2, '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': 34.0, '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': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.6', 'valuenum': 73.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.85', 'valuenum': 0.85, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, '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': '3.8', 'valuenum': 3.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.1', 'valuenum': 87.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.51', 'valuenum': 5.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.80', 'valuenum': 1.8, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.43', 'valuenum': 19.43, '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': '44.4', 'valuenum': 44.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, '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': '130', 'valuenum': 130.0, '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': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '41', 'valuenum': 41.0, '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': '708', 'valuenum': 708.0, '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': '319', 'valuenum': 319.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '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': '___', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 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': 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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 7.15, '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': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '36.1', 'valuenum': 36.1, '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': '-10', 'valuenum': -10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': 7.2, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - 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{'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': '27', 'valuenum': 27.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 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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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '___', 'valuenum': 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': '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', 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'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': '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': '27', 'valuenum': 27.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT 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___.'}, {'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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, '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': '317', 'valuenum': 317.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '8', 'valuenum': 8.0, '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': '39.0', 'valuenum': 39.0, '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': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, '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': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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}, {'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': '85.4', 'valuenum': 85.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '36.1', 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'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': 'CENTRAL VENOUS.', '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.01', 'valuenum': 5.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, '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': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 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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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '37', 'valuenum': 37.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '450', 'valuenum': 450.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '76.3', 'valuenum': 76.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 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'ref_range_upper': 36.5, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': 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': '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 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'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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, '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', 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'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': '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': '54', 'valuenum': 54.0, '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': '___', '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': '___', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '36.4', 'valuenum': 36.4, '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': '12/2.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 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{'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '26', 'valuenum': 26.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '8', 'valuenum': 8.0, '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': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, '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': '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': '263', 'valuenum': 263.0, '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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 145.0, '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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, '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': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, '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': '207', 'valuenum': 207.0, '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': '4.11', 'valuenum': 4.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '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': '0.8', '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': 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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 145.0, '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': '38.5', 'valuenum': 38.5, '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': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '240', 'valuenum': 240.0, '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': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.9', 'valuenum': 44.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 145.0, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '266', 'valuenum': 266.0, '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': '4.61', 'valuenum': 4.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '43.2', 'valuenum': 43.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.98', 'valuenum': 4.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.0', 'valuenum': 43.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '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': 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': '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}], 'exams': 'VS: T 98.9 HR 118/56 HR 82 RR 18 O2 sat 98% on RA\nGEN:\nHEENT: MMM OP clear, no exophthalmos, goiter with some \ntenderness, no nodules or bruit \nCARD: RRR, ___ SEM at the RUSB radiates to carotids\nPULM: CTAB\nABD: soft, NT, ND, no masses or organomegaly\nEXT: WWP, no c/c/e, resting fine tremor\nNEURO: aOx3, grossly normal', 'diagnoses': [{'icd_code': 'T71162A', 'desc': 'Asphyxiation due to hanging, intentional self-harm, initial encounter'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'I468', 'desc': 'Cardiac arrest due to other underlying condition'}, {'icd_code': 'J690', 'desc': 'Pneumonitis due to inhalation of food and vomit'}, {'icd_code': 'G9349', 'desc': 'Other encephalopathy'}, {'icd_code': 'G931', 'desc': 'Anoxic brain damage, not elsewhere classified'}, {'icd_code': 'S27329A', 'desc': 'Contusion of lung, unspecified, initial encounter'}, {'icd_code': 'Z781', 'desc': 'Physical restraint status'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'X838XXA', 'desc': 'Intentional self-harm by other specified means, initial encounter'}, {'icd_code': 'X58XXXA', 'desc': 'Exposure to other specified factors, initial encounter'}, {'icd_code': 'Y92007', 'desc': 'Garden or yard of unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'S1093XA', 'desc': 'Contusion of unspecified part of neck, initial encounter'}, {'icd_code': 'S2242XA', 'desc': 'Multiple fractures of ribs, left side, initial encounter for closed fracture'}, {'icd_code': 'S2221XA', 'desc': 'Fracture of manubrium, initial encounter for closed fracture'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'I671', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': 'I6521', 'desc': 'Occlusion and stenosis of right carotid artery'}, {'icd_code': 'N401', 'desc': 'Benign prostatic hyperplasia with lower urinary tract symptoms'}, {'icd_code': 'R338', 'desc': 'Other retention of urine'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'F4320', 'desc': 'Adjustment disorder, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}], 'summary': "___ WBC 1.1 with 0.4% neutrophils, ___ WBC 2.8 with 33.3%, \n___ WBC 2.0 19.9% neutrophils, ___ WBC 2.0 22N ___\nHCT ___\nPLTs ___\nTSH ___\n\n___ 05:58AM BLOOD WBC-2.4* RBC-3.22* Hgb-9.4* Hct-28.5* \nMCV-89 MCH-29.1 MCHC-32.9 RDW-16.7* Plt ___\n___ 10:35AM BLOOD WBC-2.0* RBC-2.89* Hgb-8.4* Hct-24.9* \nMCV-86 MCH-29.0 MCHC-33.6 RDW-16.5* Plt ___\n___ 10:35AM BLOOD Neuts-22* Bands-0 Lymphs-60* Monos-16* \nEos-0 Baso-0 Atyps-1* ___ Myelos-0 Other-1*\n___ 05:58AM BLOOD ___ ___\n___ 08:00AM BLOOD ___ ___\n___ 08:55AM BLOOD ___ ___\n___ 10:35AM BLOOD Ret Aut-6.1*\n___ 08:00AM BLOOD Glucose-112* UreaN-13 Creat-0.3* Na-139 \nK-4.6 Cl-106 HCO3-23 AnGap-15\n___ 08:55AM BLOOD Glucose-251* UreaN-15 Creat-0.4 Na-137 \nK-4.5 Cl-103 HCO3-22 AnGap-17\n___ 10:35AM BLOOD Glucose-98 UreaN-14 Creat-0.3* Na-139 \nK-4.3 Cl-109* HCO3-23 AnGap-11\n___ 08:00AM BLOOD ALT-61* AST-30 AlkPhos-195* TotBili-0.4\n___ 10:35AM BLOOD ALT-72* AST-51* LD(LDH)-175 AlkPhos-215* \nTotBili-0.4\n___ 10:35AM BLOOD Albumin-3.8 Calcium-8.9 Phos-3.8 Mg-1.9 \nIron-80\n___ 10:35AM BLOOD calTIBC-235* ___ Folate-15.4 \nFerritn-1079* TRF-181*\n___ 05:58AM BLOOD T4-21.6* T3-219* calcTBG-0.41* \nTUptake-2.44* ___\n___ 08:00AM BLOOD T4-27.2* T3-315* calcTBG-0.24* \nTUptake-4.17* ___\n___ 10:35AM BLOOD T4-35.0* T3-GREATER TH calcTBG-LESS THAN \nTUptake-UPTAKE CAN\nAGRANULOCYTOSIS: likely related to methimazole, normal time \ncourse for recovery is within 2 weeks. She was 22 days since \nstopping methimazole on admission. Her sore throat may have \nbeen a manifestation of this rather than a true infetion but \nwill need to confirm with previous culture results, this has \nresolved though. In addition the patient has cholestatic \npattern of LFT abnormalities which likely is representative of \nmethimazole side effects as well. Hematology was consulted and \nthought if does not recover may need bone marrow biopsy, \nhowever, her counts did recover and she did not require \nadditional neupogen after the initial dose on admission. Her ANC \non discharge was > 1000.\n\nANEMIA: Anemia of chronic inflammation.\n\nGRAVES DISEASE: In anticipation of thyroidectomy SSKI was \nstarted, in addition she was started on metoprolol 25mg po bid \nand dexamethasone 2mg po bid upon discharge. While inpt her \nsymptoms of fatigue and DOE improved significantly and her TFTs \nimproved as well. Planned surgery on ___. The \npatient's endocrinologist will call the patient on ___ \n___ to arrange repeat lab testing on ___."}}
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{'final_diagnoses': ['Graves Disease', 'Neutropenia/agranulocytosis', 'Anemia', 'Transaminitis'], 'procedures': ['None'], 'visit_summary': "AGRANULOCYTOSIS: likely related to methimazole, normal time \ncourse for recovery is within 2 weeks. She was 22 days since \nstopping methimazole on admission. Her sore throat may have \nbeen a manifestation of this rather than a true infetion but \nwill need to confirm with previous culture results, this has \nresolved though. In addition the patient has cholestatic \npattern of LFT abnormalities which likely is representative of \nmethimazole side effects as well. Hematology was consulted and \nthought if does not recover may need bone marrow biopsy, \nhowever, her counts did recover and she did not require \nadditional neupogen after the initial dose on admission. Her ANC \non discharge was > 1000.\n\nANEMIA: Anemia of chronic inflammation.\n\nGRAVES DISEASE: In anticipation of thyroidectomy SSKI was \nstarted, in addition she was started on metoprolol 25mg po bid \nand dexamethasone 2mg po bid upon discharge. While inpt her \nsymptoms of fatigue and DOE improved significantly and her TFTs \nimproved as well. Planned surgery on ___. The \npatient's endocrinologist will call the patient on ___ \n___ to arrange repeat lab testing on ___.", 'medications_prescribed': ['1. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every \n12 hours).\nDisp:*30 Tablet(s)* Refills:*0*', '2. polyvinyl alcohol-povidone 1.4-0.6 % Dropperette Sig: ___ \nDrops Ophthalmic PRN (as needed) as needed for dry eyes. ', '3. potassium iodide 1 gram/mL Solution Sig: 0.25 ML PO TID (3 \ntimes a day).\nDisp:*10 mL* Refills:*0*', '4. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One \n(1) Tablet, Chewable PO TIDAC (3 times a day (before meals)). ', '5. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily). ', '6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO twice \na 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': 52, 'gender': 'F', 'symptoms': 'abdominal pain, s/p fall', 'medical_history': ['Hypertension', 'Hypercholesterolemia', 'Aortic stenosis', "Dementia- due to Alzheimer's and possible contribution of brain \nsmall-vessel ischemic disease", 'Depression', 'Gastrointestinal bleeding', 'Diverticulosis', 'Osteopenia', 'Basal cell carcinoma', 'Squamous cell carcinoma', 'Flash pulmonary edema from ___ cardiomyopathy 1980s, \n catheterization at that time showed no evidence of CAD'], 'family_history': 'Notable for heart disease, stroke, hypertension, diabetes, skin \ncancer, renal cancer.', 'present_illness': "___ with moderate AS (valve area 1.0-1.2), HTN, AFib NOT on \nhome Coumadin, Alzheimer's dementia who came to the ED with \nabdominal pain, s/p unwitnessed fall, unable to ambulate, \nvomiting. On presentation, she was hypotensive, hypoxic, and had \nbright red blood in her urine. She was found to have \nextraperitoneal ruptured bladder and bilateral non-displaced \npubic rami fx's (R inferior and L superior). \n. \nShe was seen by Urology and Surgery on admission for evaluation \nof ruptured bladder as well as pelvic fractures. Surgical \nintervention was not indicated for either problem. Foley placed \nfor decompression.\n.\nRegarding hypotension/hypoxia, she was given IVF resuscitation \nfor hypotension and presumably became volume overloaded in the \nsetting of AS. She then developed hypoxia, initially with poor \nsats on facemask. She was not intubated. CXR was notable for RLL \ncollapse presumed due to mucus plug as well as b/l pleural \neffusions secondary to volume overload. She was initially \ndiuresed with a Lasix gtt with suboptimal effect, transitioned \nto Lasix boluses (20mg IV) with good effect (last dose IV dose \nwas at 8:30am ___. At the time of transfer to medicine, she \nwas 2.5L negative through her LOS and had O2 sats of 94-95% on \n___ O2.\n. \nOn HD2 she flipped into AFib. It was thought that pulm edema \npushed her back in AFib, so she was bolused and started on po \namiodarone. Flipped back into Afib with RVR twice in SICU, each \ntime she was bolused with 150 IV Amio and transitioned back into \nNS. At time of transfer to medicine was she was 2 days into 5 \ndays of 400mg po amiodarone TID with PO diltiazem 45mg PO QID \nper cards recs. \n. \nThere was concern for initial concern for HAP due to initial \nCXR. Received Cipro/Cefepime/Vanco for several days which were \nstopped on ___ as probability of infection low. Patient has \nbeen afebrile since admission. Chronic leukocytosis in ___ \nthought secondary to underlying PMR and chronic steroid use. \nUrine grew pseudomonas in her urine and got 1 dose of \nceftriaxone. \n. \nShe received 1u PRBC's for Hct 35 because her baseline was felt \nto be 40's. \n. \nThere was concern about her pain control and concern for \nsplinting, so had an epidural catheter placed for pain control, \nand pain service was following, using Dilaudid and Bupivicaine. \n. \nShe had an NG in for feeding that was removed as she improved, \nremoved the day of transfer to medicine. ___ has been consulted, \nneeds two person assist, has been OOB to chair qday. Pain \nService following. Epidural catheter removed prior to transfer \nto medicine.\n. \nVitals at time of transfer: 98.2 137/55 76 16 93% face tent, 96% \non 3L NC. Per reports, no need further diuresis as patient is \n-2.5L through LOS \n.\nOn the medicine floor, pt had no complaints. Saturating well on \nRA. Pt denies f/c/ns, difficulty breathing, CP, palpitations, \nn/v, abd pain.", 'medications': [{'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', '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}]}, 'clinical_findings': {'labs': [], 'exams': 'VS: 94.7 142/62 96 16 92%RA\nGen: Alert, oriented to place, person, NAD, baseline dementia\nHEENT: anicetric sclera, MMM\nNeck: Supple, no LAD\nCV: RRR, ___ systolic murmur radiating to carotid, nl s1,s2, no \nperipheral edema\nResp: scant crackles b/l, decreased bs at bases, good aeration \nGI: soft, NT, ND, +BS, no guarding, no rebound\nExt: warm, well perfused, several eccyhmosis, no cyanosis\nSkin: several eccyhmosis\nNeuro: no focal deficits', 'diagnoses': [{'icd_code': 'L732', 'desc': 'Hidradenitis suppurativa'}, {'icd_code': 'L910', 'desc': 'Hypertrophic scar'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6841', 'desc': 'Body mass index [BMI] 40.0-44.9, adult'}], 'summary': "Admission Labs:\n\n___ 06:50AM BLOOD WBC-18.3* RBC-4.72 Hgb-13.6 Hct-40.6 \nMCV-86 MCH-28.7 MCHC-33.4 RDW-14.7 Plt ___\n___ 06:50AM BLOOD Neuts-51 Bands-5 ___ Monos-2 Eos-0 \nBaso-0 ___ Myelos-0 NRBC-1*\n___ 06:50AM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 06:50AM BLOOD Plt Smr-NORMAL Plt ___\n___ 06:50AM BLOOD ___ PTT-20.0* ___\n___ 06:50AM BLOOD Glucose-115* UreaN-47* Creat-1.7* Na-141 \nK-2.9* Cl-99 HCO3-26 AnGap-19\n___ 06:50AM BLOOD cTropnT-<0.01\n___ 12:48PM BLOOD Calcium-7.6* Phos-3.3 Mg-1.3*\n___ 01:04PM BLOOD Type-ART ___-___* pCO2-45 pH-7.30* \ncalTCO2-23 Base XS--3 Intubat-NOT INTUBA\n\nAdmission CXR: 1. Left costophrenic angle blunting likely \nrepresents consolidation or effusion.\n2. No evidence of rib fractures; if clinical concern for rib \nfracture,\ndedicated rib series is recommended.\n\nCT CAP ___: Extraperitoneal bladder rupture.\nNo evidence of solid organ injury. No evidence of active \nextravasation however limited by presence of extraluminal \ncontrast from prior cystogram.\nRight inferior and left superior pubic rami fractures with \nminimal\ndisplacement and small hematoma. Minimal mesenteric stranding in \nthe right abdomen can be seen in a setting of blunt trauma, CT \nis not sensitive in delineation of bowel injury.\n\nCT head ___: No acute intracranial process\n\n___ UCx with pan sensitive Pseudomonas ___ and ___ Strep \nbovis (presumptive) \n\nEcho ___: 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 normal \n(LVEF>55%). Right ventricular chamber size and free wall motion \nare normal. The aortic valve leaflets (3) are mildly thickened. \nThere is moderate aortic valve stenosis (valve area 1.0-1.2cm2). \nMild (1+) aortic regurgitation is seen. The mitral valve \nleaflets are mildly thickened. Mild to moderate (___) mitral \nregurgitation is seen. The tricuspid valve leaflets are mildly \nthickened. Moderate [2+] tricuspid regurgitation is seen. There \nis moderate pulmonary artery systolic hypertension. There is no \npericardial effusion.\n\nCystogram ___: Persistent small anterolateral bladder leak, \ncorrelating appropriately with the site of extraperitoneal \nbladder rupture demonstrated on CT from ___. \n\nDischarge Labs:\n___ 06:30AM BLOOD ___-23.3* RBC-3.98* Hgb-11.4* Hct-34.0* \nMCV-85 MCH-28.7 MCHC-33.6 RDW-15.0 Plt ___\n___ 06:30AM BLOOD Plt ___\n___ 06:30AM BLOOD Glucose-110* UreaN-35* Creat-0.8 Na-139 \nK-3.9 Cl-104 HCO3-24 AnGap-15\n___ 06:30AM BLOOD Calcium-8.9 Phos-2.6* Mg-2.___\nPatient presented to ED and after foley catheter \nplacement bright red blood was drained from the bladder. The \npatient required IVF resuscitation for hypotension. Imaging was \nperformed. CT Torso showed extraperitoneal bladder rupture, as \nwell as R Inf and L Sup Pubic rami fx \nUrology and orthopedic surgery were consulted. Orthopedic \nsurgery recommended non-operative managment of the superior \npubic rami fracture and weight bearing as tolerated. Urology \nrecommended conservative management of the bladder injury with a \nrepeat cystogram at HD 10. The patient was admitted to the SICU \ngiven her co-morbidities most notably her history of aortic \nstenosis and cardiomyopathy.\n.\nSICU Events:\n___ Low thoracic epidural placed for pain management, \nbupivicaine 0.05% w/ 10mcg hydromorphone \n___ TTE completed with mild-mod MR, severe AS, EF 65%. \n\nSICU Course by systems: \nNeurologic: alert,arousable, oriented to person. Known history \nof alzheimer's dementia with sundowning overnight. Pain \ncontrolled epidural, no boluses; no ortho intervention for now, \nweight bearing as tolerated. Epidural for pain control while in \nICU. \nCardiovascular: Started patient on amiodarone for a fib; had \nbeen in sinus but went back into a fib with rate in 120s on ___ \npm. On ___ gave repeat amio bolus and increased dose to 400mg \nTID. Decreased dilt to 45mg QID. Lasix 20mg x 2 for fluid \nmobilization for goal UOP 1L. Started ASA per cards. \nPulmonary: Pt with fluid overload and ? hospital aquire PNA-now \noff abx. Pt with significant improvement with O2 requirements. \nPatient was gently diuresed ~500 cc negative per day as a goal. \n___ to chair while in ICU. \nGastrointestinal / Abdomen: extraperitoneal bladder rupture; \nstable with foley catheter in place. Urology following. \nCystogram planned for HD 10 \nNutrition: Patient received TF via NGT. After the patient was \ntolerating clears around her feeding tube her tube was removed \nand her diet was advanced.\nRenal: foley decompression of bladder as bladder injury \nnon-operative; Continued with lasix bolus goal -500cc/24h. Cr \nstable even with diuresis. \nHematology: Hct stable, elevated wbc stable (chronic issue) \nInfectious disease: CXR improved and clinical pulmonary function \nimproved so abx were discontinued. UA positive for PSEUDOMONAS \nAERUGINOSA was treated with 3d abx \nEndocrine: no issues ISS BG>150. \n.\nGiven that there were no active surgical issues and the patient \nsignificant medical co-morbidities when the patient was stable \nfrom floor transfer she was transferred to the medical service \nto continue managing her. She was planned for a cystogram on HD \n10.\n.\nMedicine course:\n1) Hypoxia/SOB: Likely multifactorial (atelectasis, collapse of \nRLL ___ mucus plug: resolved) however primary etiology likely \nCHF exacerbation/volume overload after aggressive fluid \nrescusitation for hypotension in the midst of trauma evaluation \nin ED. CXR's with initial L costophrenic angle blunting later \ncalled as possible epicardial fat pad; however through her \ncourse also then developed R small pleural effusion--small \npleural effusions not likely source of hypoxia but more likely \nevidence of volume overload in presence of vascular engorgement. \nAS and AFib with resultant loss of atrial kick are likely \netiologies for volume accumulation in her lungs. She was \ndiuresed with IV Lasix, and then started on 20mg po daily. LOS \nnegative ___. She initially required supplemental O2, but at \ntime of d/c has sats of 94-95% on RA. Due to her Hx of COPD, she \nwas started on Xopenex nebs, and a fluticasone inhaler was \nadded. Wheezy lung sounds improved. Daily weights and Is&Os were \nmonitored throughout her hospital course. She will benefit from \nchest pt and getting up out of bed as much as possible during \nher rehabilitation to mobilize fluids and prevent atelectasis. \nGiven that her PO intake has been poor she has not required \nfurther lasix and will be discharged without a diuretic. If her \nPO intake increases and she begins to show signs of volume \noverload she may need to have some PO lasix again.\n.\n2) AF with RVR: Rate controlled with amiodarone and diltiazem in \nthe SICU, not on coumadin secondary to PMR and h/o of frequent \nfalls btu was on ASA 325mg daily. As noted in SICU course, \ncardiology was consulted, and patient was amiodorone loaded with \n5 days of 400mg TID. At time of d/c she was on day ___ of 400mg \nBID. Starting ___, she will be on 400mg daily. She will follow \nup with cardiology as an outpatient. Cardiology also recommended \na full ASA daily. Diltiazem 45mg QID was changed to extended \nrelease form 180mg daily with good BP and HR control for several \ndays prior to discharge.\n.\n3) Extraperitoneal bladder rupture: Per urology recs repeat \ncystogram performed ___, which still showed some leakage of \ndye. Urology recommend keeping foley in place and getting \nanother cystogram in one week. Urology will see her and \ndetermine if foley can be d/c after the repeat study. \n.\n6) Pelvic fractures: Non-operative. Patient continued on Tylenol \n1g q8 hrs and oxycodone 5mg PRN pain. She will follow with ortho \nas an outpatient. Her pain was well-controlled on this regimen. \nShe should continue to work with ___ to improve functional \nstatus.\n. \n7) UTI: UCx in SICU showed pseudomonas but patient only recevied \n3 days of broad spectrum cephalosporin (they were treating HCAP \nnot a UTI at the time the cultures were not back). A repeat \nurine Cx also grew pan-sensitive Pseudomonas, however, so the \npatient was started on Cipro 500mg BID. She will get a ___s outlined in the page one as with foley in place this \nis a complicated UTI. \n.\n8) PMR: Seen by Rheumatology as outpatient. Continue prednisone \n10mg daily.\n.\n9) Chronic Leukocytosis: per old notes from hematology here this \nis felt secondary to underlying PMR. WBC count did rise from \nbaseline of about 20 to 29, but WBCs trended downward when \nCipro was started for UTI. Her baseline white count is in the \nlow-20s range.\n. \n10) Code: DNR/DNI confirmed with family. Palliative care \nconsulted at family's request. Family is interested in pursuing \nhospice care if patient does not improve with rehab and may wish \nto discuss this more with our palliative care team here as well \nas any resources available through the rehab facility.\n.\n11) Thrombocytopenia: The patient is noted to have platelets \nfrom 600-900 during this hospital stay with previous workup from \nhematology (including JAK mutation) negative for other causes \nand thought ___ her PMR. Patient was asymptomatic and platelet \ncount relatively stable and at baseline throughout her hospital \nstay."}}
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{'final_diagnoses': ['pelvic fracture', 'bladder rupture', 'aortic stenosis', 'atrial fibrilation', 'diastolic CHF (acute)'], 'procedures': ['none', 'patient will be d/c with foley in place and urology f/u'], 'visit_summary': "Patient presented to ED and after foley catheter \nplacement bright red blood was drained from the bladder. The \npatient required IVF resuscitation for hypotension. Imaging was \nperformed. CT Torso showed extraperitoneal bladder rupture, as \nwell as R Inf and L Sup Pubic rami fx \nUrology and orthopedic surgery were consulted. Orthopedic \nsurgery recommended non-operative managment of the superior \npubic rami fracture and weight bearing as tolerated. Urology \nrecommended conservative management of the bladder injury with a \nrepeat cystogram at HD 10. The patient was admitted to the SICU \ngiven her co-morbidities most notably her history of aortic \nstenosis and cardiomyopathy.\n.\nSICU Events:\n___ Low thoracic epidural placed for pain management, \nbupivicaine 0.05% w/ 10mcg hydromorphone \n___ TTE completed with mild-mod MR, severe AS, EF 65%. \n\nSICU Course by systems: \nNeurologic: alert,arousable, oriented to person. Known history \nof alzheimer's dementia with sundowning overnight. Pain \ncontrolled epidural, no boluses; no ortho intervention for now, \nweight bearing as tolerated. Epidural for pain control while in \nICU. \nCardiovascular: Started patient on amiodarone for a fib; had \nbeen in sinus but went back into a fib with rate in 120s on ___ \npm. On ___ gave repeat amio bolus and increased dose to 400mg \nTID. Decreased dilt to 45mg QID. Lasix 20mg x 2 for fluid \nmobilization for goal UOP 1L. Started ASA per cards. \nPulmonary: Pt with fluid overload and ? hospital aquire PNA-now \noff abx. Pt with significant improvement with O2 requirements. \nPatient was gently diuresed ~500 cc negative per day as a goal. \n___ to chair while in ICU. \nGastrointestinal / Abdomen: extraperitoneal bladder rupture; \nstable with foley catheter in place. Urology following. \nCystogram planned for HD 10 \nNutrition: Patient received TF via NGT. After the patient was \ntolerating clears around her feeding tube her tube was removed \nand her diet was advanced.\nRenal: foley decompression of bladder as bladder injury \nnon-operative; Continued with lasix bolus goal -500cc/24h. Cr \nstable even with diuresis. \nHematology: Hct stable, elevated wbc stable (chronic issue) \nInfectious disease: CXR improved and clinical pulmonary function \nimproved so abx were discontinued. UA positive for PSEUDOMONAS \nAERUGINOSA was treated with 3d abx \nEndocrine: no issues ISS BG>150. \n.\nGiven that there were no active surgical issues and the patient \nsignificant medical co-morbidities when the patient was stable \nfrom floor transfer she was transferred to the medical service \nto continue managing her. She was planned for a cystogram on HD \n10.\n.\nMedicine course:\n1) Hypoxia/SOB: Likely multifactorial (atelectasis, collapse of \nRLL ___ mucus plug: resolved) however primary etiology likely \nCHF exacerbation/volume overload after aggressive fluid \nrescusitation for hypotension in the midst of trauma evaluation \nin ED. CXR's with initial L costophrenic angle blunting later \ncalled as possible epicardial fat pad; however through her \ncourse also then developed R small pleural effusion--small \npleural effusions not likely source of hypoxia but more likely \nevidence of volume overload in presence of vascular engorgement. \nAS and AFib with resultant loss of atrial kick are likely \netiologies for volume accumulation in her lungs. She was \ndiuresed with IV Lasix, and then started on 20mg po daily. LOS \nnegative ___. She initially required supplemental O2, but at \ntime of d/c has sats of 94-95% on RA. Due to her Hx of COPD, she \nwas started on Xopenex nebs, and a fluticasone inhaler was \nadded. Wheezy lung sounds improved. Daily weights and Is&Os were \nmonitored throughout her hospital course. She will benefit from \nchest pt and getting up out of bed as much as possible during \nher rehabilitation to mobilize fluids and prevent atelectasis. \nGiven that her PO intake has been poor she has not required \nfurther lasix and will be discharged without a diuretic. If her \nPO intake increases and she begins to show signs of volume \noverload she may need to have some PO lasix again.\n.\n2) AF with RVR: Rate controlled with amiodarone and diltiazem in \nthe SICU, not on coumadin secondary to PMR and h/o of frequent \nfalls btu was on ASA 325mg daily. As noted in SICU course, \ncardiology was consulted, and patient was amiodorone loaded with \n5 days of 400mg TID. At time of d/c she was on day ___ of 400mg \nBID. Starting ___, she will be on 400mg daily. She will follow \nup with cardiology as an outpatient. Cardiology also recommended \na full ASA daily. Diltiazem 45mg QID was changed to extended \nrelease form 180mg daily with good BP and HR control for several \ndays prior to discharge.\n.\n3) Extraperitoneal bladder rupture: Per urology recs repeat \ncystogram performed ___, which still showed some leakage of \ndye. Urology recommend keeping foley in place and getting \nanother cystogram in one week. Urology will see her and \ndetermine if foley can be d/c after the repeat study. \n.\n6) Pelvic fractures: Non-operative. Patient continued on Tylenol \n1g q8 hrs and oxycodone 5mg PRN pain. She will follow with ortho \nas an outpatient. Her pain was well-controlled on this regimen. \nShe should continue to work with ___ to improve functional \nstatus.\n. \n7) UTI: UCx in SICU showed pseudomonas but patient only recevied \n3 days of broad spectrum cephalosporin (they were treating HCAP \nnot a UTI at the time the cultures were not back). A repeat \nurine Cx also grew pan-sensitive Pseudomonas, however, so the \npatient was started on Cipro 500mg BID. She will get a ___s outlined in the page one as with foley in place this \nis a complicated UTI. \n.\n8) PMR: Seen by Rheumatology as outpatient. Continue prednisone \n10mg daily.\n.\n9) Chronic Leukocytosis: per old notes from hematology here this \nis felt secondary to underlying PMR. WBC count did rise from \nbaseline of about 20 to 29, but WBCs trended downward when \nCipro was started for UTI. Her baseline white count is in the \nlow-20s range.\n. \n10) Code: DNR/DNI confirmed with family. Palliative care \nconsulted at family's request. Family is interested in pursuing \nhospice care if patient does not improve with rehab and may wish \nto discuss this more with our palliative care team here as well \nas any resources available through the rehab facility.\n.\n11) Thrombocytopenia: The patient is noted to have platelets \nfrom 600-900 during this hospital stay with previous workup from \nhematology (including JAK mutation) negative for other causes \nand thought ___ her PMR. Patient was asymptomatic and platelet \ncount relatively stable and at baseline throughout her hospital \nstay.", 'medications_prescribed': ['1. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H \n(Every 8 Hours).', '4. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.\nDisp:*12 Tablet(s)* Refills:*0*', '5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff \nInhalation BID (2 times a day).\nDisp:*1 inhaler* Refills:*2*', '6. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times \na day) for 9 doses: Take 2 times per day until ___.\nDisp:*9 Tablet(s)* Refills:*0*', '7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours) for 12 days: Please finish all of this \nmedicine. .\nDisp:*23 Tablet(s)* Refills:*0*', '8. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily).\nDisp:*30 Capsule, Sustained Release(s)* Refills:*2*', '9. Escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '10. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \n___ puffs Inhalation every six (6) hours as needed for shortness \nof breath or wheezing.\nDisp:*1 inhaler* Refills:*2*', '11. cystogram\nUrology would like you to have a cystogram about 1 week after \ndischarge so they can decide whether or not it is sfae to remove \nthe unine catheder.', '12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day.', '13. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '14. Calcium 500 + D (D3) 500-125 mg-unit Tablet Sig: One (1) \nTablet PO twice a day.', '15. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day: \nhold for loose stools.', '16. Multivitamin Tablet Sig: One (1) Tablet PO once a day.', '17. Iron 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO once \na day.']}
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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': 'dyspnea', 'medical_history': ['1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, +Hypertension', '2. CARDIAC HISTORY: \n- aortic insufficiency: mild on ___ echo\n- mitral regurgitation: mild/mod on ___ echo\n- IMI ___, cath revealed diffused disease in RCA, treated \nmedically\n- CABG: None \n- PERCUTANEOUS CORONARY INTERVENTIONS: LAD stent in ___\n- ETT MIBI in ___ moderate fixed inf defect, echo EF 40-45%', '3. OTHER PAST MEDICAL HISTORY: \nGERD\nMacular degeneration\ns/p cholecystectomy'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death; otherwise non-contributory.', 'present_illness': "___ with CAD, mild-moderate mitral regurgitation, mild aortic \nregurgitation and HTN presenting with dyspnea x 1 week. Pt was \nseen by PCP ___ ___ for dyspnea on exertion; she was observed by \nher daughter to be short of breath after one flight of stairs, \nwhich was a change from baseline. At that visit, she was found \nto have new-onset Afib. Pt's metoprolol was increated to 100mg \nin AM and 50mg in ___, and pt was started on pradaxa 75 BID. \nSince then, she has had worsening dyspnea. Last night, she \ncouldn't sleep at all due to orthopnea and PND, so she had her \ndaughter bring her to the ED. She was also feeling lightheaded \nyesterday, but that has resolved. She denies feeling \npalpitations, or chest discomfort.\n\nIn the ED, initial vitals were 97.6 106 140/92 20 100% Nasal \nCannula. \n- CXR showed pulmonary edema and small bilateral pleural \neffusion\n- pro BNP 7970\n- Pt given lasix 20mg IV\n\nOn review of systems, she denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, black stools or \nred stools. She denies recent fevers, chills or rigors. She has \nan occasional non-productive cough that is chronic. She denies \nurinary urgency, frequency or dysuria.", '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 (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pregabalin', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'TraZODone', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', '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}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QHS', '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': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '36', 'valuenum': 36.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', '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', '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, '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': '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': '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': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION\nVS: 97.1 141/95 86 18 96%RA Wt 48.7kg\nGeneral: Very pleasant thin elderly woman in no distress\nHEENT: MMM \nNeck: No JVD \nCV: irregularly irregular, nl s1/s2, no murmur appreciated\nLungs: Crackles ___ way up bilaterally \nAbdomen: soft, NT, normoactive BS\nGU: no foley\nExt: warm, no edema\nNeuro: AAOx3\nSkin: no rashes noted\nPULSES: 2+ radial\n\nDISCHARGE\nVS: AF 97.5 BP 115-149/60-75 HR ___ RR ___ 97-99% RA\nGeneral: Very pleasant thin elderly woman in no distress\nHEENT: MMM \nNeck: No JVD \nCV: irregularly irregular, normocardic, nl s1/s2, no murmur \nappreciated\nLungs: Crackles bilateral bases, decreased from yesterday \nAbdomen: soft, NT, normoactive BS\nGU: no foley\nExt: warm, trace edema around ankles\nNeuro: AAOx3, no focal deficit\nSkin: no rashes noted\nPULSES: 2+ radial and DP', 'diagnoses': [{'icd_code': 'S72091A', 'desc': 'Other fracture of head and neck of right femur, initial encounter for closed fracture'}, {'icd_code': 'S52592A', 'desc': 'Other fractures of lower end of left radius, initial encounter for closed fracture'}, {'icd_code': 'W108XXA', 'desc': 'Fall (on) (from) other stairs and steps, initial encounter'}, {'icd_code': 'Y9229', 'desc': 'Other specified public building as the place of occurrence of the external cause'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': 'ADMISSION LABS\n___ 08:20AM BLOOD WBC-8.0 RBC-4.55 Hgb-11.7* Hct-38.8 \nMCV-85 MCH-25.6* MCHC-30.0* RDW-15.5 Plt ___\n___ 08:20AM BLOOD ___ PTT-60.3* ___\n___ 08:20AM BLOOD Glucose-108* UreaN-25* Creat-1.0 Na-135 \nK-4.5 Cl-101 HCO3-22 AnGap-17\n___ 08:20AM BLOOD ALT-187* AST-223* AlkPhos-142* \nTotBili-0.6\n___ 08:20AM BLOOD Lipase-28\n___ 08:20AM BLOOD cTropnT-<0.01\n___ 08:20AM BLOOD proBNP-7970*\n___ 08:20AM BLOOD Albumin-3.9\n\nDISCHARGE LABS\n___ 05:40AM BLOOD WBC-7.1 RBC-4.18* Hgb-10.6* Hct-35.9* \nMCV-86 MCH-25.4* MCHC-29.6* RDW-15.0 Plt ___\n___ 05:40AM BLOOD Glucose-80 UreaN-24* Creat-0.9 Na-139 \nK-3.9 Cl-101 HCO3-28 AnGap-14\n___ 05:40AM BLOOD ALT-60* AST-31 AlkPhos-106* TotBili-0.5\n___ 05:40AM BLOOD Calcium-9.2 Phos-3.2 Mg-1.8\n\n___ CXR\nFINDINGS: The lungs are well expanded. There are diffuse \nbilateral \ninterstitial opacities, more predominant in the lung bases, with \n___ B \nlines and associated small bilateral pleural effusions. Cardiac \nsize is \nslightly enlarged allowing for limitations of this AP view. \nSignificant \natherosclerotic calcifications of the aortic arch are present. \nThere is no pneumothorax. Evidence of a large hiatal hernia is \nagain seen. Left axillary soft tissue calcifications are again \nseen. \nIMPRESSION: Acute pulmonary edema with associated bilateral \npleural effusions. \n\n___ TTE:\nThe left atrial volume is moderately increased.. Left \nventricular wall thicknesses and cavity size are normal. The \nremaining segments contract normally (LVEF = 45%). Right \nventricular chamber size and free wall motion are normal. The \nascending aorta is mildly dilated. The aortic valve leaflets (3) \nare mildly thickened but aortic stenosis is not present. \nModerate (2+) aortic regurgitation is seen. The mitral valve \nleaflet are slightly thickened. There is mild MAC. Moderate to \nsevere (3+) mitral regurgitation is seen. Moderate [2+] \ntricuspid regurgitation is seen. There is moderate pulmonary \nartery systolic hypertension. Significant pulmonic regurgitation \nis seen. There is no pericardial effusion. \nIMPRESSION: Mild regional left ventricular systolic dysfunction, \nc/w CAD. Moderate aortic regurgitation. Moderate to severe \nmitral regurgitation. Moderate tricuspid regurgitation. Moderate \npulmonary hypertension.\nCompared with the prior study (images reviewed) of ___, \nseverity of aortic, mitral and tricuspid regurgitation has \nincreased. Pulmonary pressures have increased.\n___ with CAD s/p PCI to LAD, sCHF (EF 45-50%), presenting with \nnew-onset Afib and heart failure exacerbation.\n\n# Afib with RVR: Initially presented with rates in 110-130s, \nincreased beta blockade to metoprolol succinate 200mg with \nimprovement in HR ___. Switched anticoagulation from \npradaxa to apixaban given better safety profile of apixaban in \nelderly patients. Underwent cardioversion ___ with partial \nsuccess, pt remained in irregular rhythm shortly after \ncardioversion (?wandering atrial pacemaker), but now in sinus \nrhythm with PACs. Patient started on amiodarone for further \nmanagement of Afib, started on loading dose amiodarone 200mg bid \nx 1 week, will then go to 200mg daily. \n \n# Acute on chronic sCHF (LVEF 45%): Pt presented with signs of \nleft-sided volume overload and CXR significant for pulmonary \nedema and b/l pleural effusions. Pt was diuresed with lasix 20mg \nIV boluses with rapid improvement in dyspnea, orthopnea and PND, \ndischarged on lasix 20mg PO. Echo showed unchanged EF from prior \nat 45%, also with moderate-to-severe MR, moderate TR/AR. Pt \nmaintained on lisinopril 20mg (Med Rec revealed that patient \nactually takes lisinopril 30mg at home, but continued on 20mg \ngiven good BP and new lasix). \n \n# Acute transaminitis: likely due to hepatic venous congestion \n___ heart failure exacerbation. Improved with diuresis.'}}
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{'final_diagnoses': ['Atrial fibrillation with RVR', 'decompensated systolic CHF'], 'procedures': ['DC cardioversion'], 'visit_summary': '___ with CAD s/p PCI to LAD, sCHF (EF 45-50%), presenting with \nnew-onset Afib and heart failure exacerbation.\n\n# Afib with RVR: Initially presented with rates in 110-130s, \nincreased beta blockade to metoprolol succinate 200mg with \nimprovement in HR ___. Switched anticoagulation from \npradaxa to apixaban given better safety profile of apixaban in \nelderly patients. Underwent cardioversion ___ with partial \nsuccess, pt remained in irregular rhythm shortly after \ncardioversion (?wandering atrial pacemaker), but now in sinus \nrhythm with PACs. Patient started on amiodarone for further \nmanagement of Afib, started on loading dose amiodarone 200mg bid \nx 1 week, will then go to 200mg daily. \n \n# Acute on chronic sCHF (LVEF 45%): Pt presented with signs of \nleft-sided volume overload and CXR significant for pulmonary \nedema and b/l pleural effusions. Pt was diuresed with lasix 20mg \nIV boluses with rapid improvement in dyspnea, orthopnea and PND, \ndischarged on lasix 20mg PO. Echo showed unchanged EF from prior \nat 45%, also with moderate-to-severe MR, moderate TR/AR. Pt \nmaintained on lisinopril 20mg (Med Rec revealed that patient \nactually takes lisinopril 30mg at home, but continued on 20mg \ngiven good BP and new lasix). \n \n# Acute transaminitis: likely due to hepatic venous congestion \n___ heart failure exacerbation. Improved with diuresis.', 'medications_prescribed': []}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'M', 'symptoms': 'Weakness', 'medical_history': ['-Cadaveric renal transplant ___ (on tacrolimus, prednisone and \ncellcept)', '-CVA with residual right hemiparesis', '-Systolic Dysfunction (TTE in ___ with EF of 35-40%)', '-DM Type I complicated by nephropathy', '-ESRD', '-HTN', '-HLD', '-CAD s/p CABG in ___', '-Vfib arrest ___ with anoxic brain injury', '-hx of aspiration pneumonia s/p PEG ___', '-Tracheomalacia after long intubation requiring trach placement \nwith transition to size ___ ___ cannula (T tube)', '-hx of tracheobronchitis due to pseudomonas, E.coli (most recent \nadmit ___', '- legally blind'], 'family_history': 'No history of lung disease', 'present_illness': ' Mr. ___ is a ___ gentleman with a history of CVA with \nresidual right sided hemiparesis, type 1 diabetes, renal \ntransplant (cadaveric in ___ on tacrolimus, CAD s/p CABG, v \nfib arrest with anoxic brain injury (___), h/o recurrent \naspiration pneumonia, tracheomalacia s/p tracheostomy, and \nrecent ICU admission for hypotension and pneumonia, sent to the \nED from home after ___ found sodium to be 122. Na was 133 on \ndischarge on ___. \nWife reports he is less responsive. He has not opened his eyes \nall day. He responds to his wife but less so. He has bruising on \nhis sides x1 week and his wife believes it is from the \ncaretakers lifting him incorrectly. He is not on coumadin. CT \nhead, chest, abdomen, pelvis done to r/o trauma. Per wife, no \nfever, chills, N/V, diarrhea. His lasix dose was adjusted \nseveral times recently. \nHe was recently admitted from ___ with sepsis from \nHCAP/aspiration pneumonia and hyponatremia thought to be due to \nvolume depletion. He was fluid resuscitated and developed \npulmonary edema in the setting of sCHF (EF 35-40%). He was \ndiuresed but developed contraction alkalosis. On discharge, \ninstructions were given to dose lasix only based on symptoms \nwith no scheduled administrations.\nPrior to this, Mr. ___ was admitted to ___ from \n___ for P. aeruginosa cellulitis of the left foot \ntreated with 6 weeks of ciprofloxacin and flagyl.\nIn the ED, initial vitals were: 98.0 79 119/56 20 96%. Labs were \nnotable for Na 117, rechecked at 122. Cl 88. Hct 23.1 (26.4 on \n___. \nVitals on transfer 99.8 84 136/51 14 95% RA \nReview of systems: Unable', 'medications': [{'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nitroprusside Sodium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nitroglycerin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Labetalol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', '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': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', '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': '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': '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SL', 'frequency': 'ONCE MR1', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': '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': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'X1', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Rosuvastatin Calcium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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}]}, 'clinical_findings': {'labs': [{'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '258', 'valuenum': 258.0, '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': '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', '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': '9', 'valuenum': 9.0, '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': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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 = 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': 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': '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': '3.3', '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': '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 183.0, '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': '12', 'valuenum': 12.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.12, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 251.0, 'valueuom': 'mg/dL', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, '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': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 313.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '259', 'valuenum': 259.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 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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': 394.0, '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': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.23, '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', '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': '___', 'valuenum': 265.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 199.0, 'valueuom': 'mg/dL', '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.34, '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': '35', 'valuenum': 35.0, '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': 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': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', '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': '198', 'valuenum': 198.0, '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': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 201.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.42, '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': '___', 'valuenum': 178.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.47, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 156.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '___', 'valuenum': 0.53, '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION:\n==========\nVitals- 98.7, 84, 114/52, 10, 94%RA\nGeneral: Alert, not responsive or verbal, does not follow \ncommands\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated \nLungs: rhonchorous throughout with decresed breath sounds at \nboth bases \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly. G tube \npresent. Site has erythema and some granulation tissue\nGU: foley present \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \n\nFICU CALL OUT EXAM ___:\n============================\nTmax: 36.3 °C (97.4 °F)\nTcurrent: 36.3 °C (97.4 °F)\nHR: 57 (49 - 72) bpm\nBP: 102/29(46) {36/21(22) - 136/76(79)} mmHg\nRR: 17 (12 - 22) insp/min\nSpO2: 99% \nHeart rhythm: SB (Sinus Bradycardia)\nGeneral: Alert, not responsive or verbal, does not follow \ncommands\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated + trach c/d/i\nLungs: rhonchorous throughout with decresed breath sounds at \nboth bases \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly. G tube \npresent. Site has erythema and some granulation tissue\nGU: foley present \nExt: cool, weak pulses. +left forefoot with necrotic ulcer with \ntrace purulent drainage no surrounding erythema, left heel with \nunstageable ulcer. bilateral toes with dry ulcers \n\nDischarge exam:\nPhysical exam\nafebril3 116/47 HR 76 RR 22 100% RA\n___ 165 this am, up to 212.\nI/Os difficult to interpret - but probably even\nGeneral: chronically ill appearing, lying on side. \nHEENT: eyes closed. facial edema persistent. Trach with mask.\nLungs coarse anteriorly\nCV RRR without murmurs\nAbdomen soft, NT, ND, NABS. G tube in place. Ecchymoses on\nflanks and forearms. \nExt: edema of hands and face, scrotum and penis decreased \nNeuro: contracted, lying on side. \nSkin: multiple areas of dry gangrene on feet, on right great\ntoe. Left great toe with purulent drainage, able to express \nfrom\nbelow gangrenous area, new since yesterday.', 'diagnoses': [{'icd_code': '44023', 'desc': 'Atherosclerosis of native arteries of the extremities with ulceration'}, {'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '70715', 'desc': 'Ulcer of other part of foot'}, {'icd_code': '5989', 'desc': 'Urethral stricture, unspecified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V707'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}], 'summary': "ADMISSION LABS:\n===============\n\n___ 07:10PM PLT COUNT-243#\n___ 07:10PM NEUTS-90.6* LYMPHS-5.3* MONOS-3.2 EOS-0.8 \nBASOS-0.1\n___ 07:10PM WBC-4.8 RBC-2.40* HGB-7.6* HCT-23.1* MCV-96 \nMCH-31.8 MCHC-33.1 RDW-17.2*\n___ 07:10PM OSMOLAL-260*\n___ 07:10PM CALCIUM-7.3* PHOSPHATE-2.7 MAGNESIUM-1.7\n___ 07:10PM estGFR-Using this\n___ 07:10PM GLUCOSE-190* UREA N-27* CREAT-0.5 SODIUM-117* \nPOTASSIUM-4.6 CHLORIDE-88* TOTAL CO2-25 ANION GAP-9\n___ 07:10PM GLUCOSE-190* UREA N-27* CREAT-0.5 SODIUM-117* \nPOTASSIUM-4.6 CHLORIDE-88* TOTAL CO2-25 ANION GAP-9\n___ 09:08PM ___ PTT-32.4 ___\n\nADMISSION LABS:\n===============\n___ 06:15AM BLOOD WBC-3.8* RBC-2.37* Hgb-7.4* Hct-22.7* \nMCV-96 MCH-31.3 MCHC-32.7 RDW-17.3* Plt ___\n___ 06:15AM BLOOD Plt ___\n___ 06:15AM BLOOD ___ PTT-35.1 ___\n___ 06:15AM BLOOD Glucose-118* UreaN-30* Creat-0.6 Na-127* \nK-4.6 Cl-97 HCO3-25 AnGap-10\n___ 06:15AM BLOOD Calcium-7.5* Phos-3.4 Mg-1.9\n___ 12:16PM BLOOD Iron-25*\n___ 12:16PM BLOOD calTIBC-147* Ferritn-90 TRF-113*\n___ 06:15AM BLOOD Cortsol-9.5\n___ 11:58AM BLOOD tacroFK-15.6\n\nImages: \n===============\nCT HEAD ___: \nNo acute intracranial process. Chronic intracranial changes.\nNear-complete opacification of the left sphenoid sinus as on \nprior with high-density internal components potentially due to \ninspissated secretions although fungal superinfection is \npossible. \n\nCT ___ ___:\n1. Large right greater than left pleural effusions. Bilateral \nlower lobe collapse which causes narrowing of the lower lobe \nbronchi.\n2. Anasarca. No free fluid or free air.\n3. Ground glass opacities in the upper lobes could be due to \npulmonary edema\nor infection.\n4. Cardiomegaly and coronary artery calcifications.\n5. Cystic lesion near the head of the pancreas has decreased \nsince ___. \n6. No fractures identified.\n\nECHO ___:\nThe left atrium is mildly dilated. There is mild symmetric left \nventricular hypertrophy with normal cavity size and global \nsystolic function (LVEF>55%) [SAYS 35-40% IN REPORT]. There is \nmoderate regional left ventricular systolic dysfunction with \ninferior and inferolateral akinesis. Right ventricular chamber \nsize and free wall motion are normal. The aortic valve leaflets \n(3) are mildly thickened but aortic stenosis is not present. \nMild (1+) aortic regurgitation is seen. The mitral valve \nleaflets are myxomatous. There is mild bileaflet mitral valve \nprolapse. Mild to moderate (___) mitral regurgitation is seen. \nThe tricuspid valve leaflets are mildly thickened. The estimated \npulmonary artery systolic pressure is normal. There is no \npericardial effusion. \n\nIMPRESSION: Mild symmetric LVH with regional left ventricular \nsystolic dysfunction as described above. Myxomatous appearing \nmitral leaflets with mild bileaflet prolapse and mild to \nmoderate mitral regurgitation. Mild aortic regurgitation. \n\nCompared with the report of the prior study (images unavailable \nfor review) of ___, the wall motion abnormalities are \nsimilar. The mitral leaflets appear myxomatous with mild \nprolapse and slight increase in mitral regurgitation. Mild \naortic regurgitation is seen. \n\nEKG: Sinus rhythm, rate 77, LAD, ?LBBB, unchanged from prior. \nSignificant baseline artifact.\n\nHgba1c 5.7\n___\n\nDischarge labs\n \n\n___ 08:08AM BLOOD WBC-5.2 RBC-2.45* Hgb-7.8* Hct-24.5* \nMCV-100* MCH-31.8 MCHC-31.8 RDW-16.8* Plt ___\n___ 05:56AM BLOOD Glucose-68* UreaN-25* Creat-0.5 Na-135 \nK-4.8 Cl-102 HCO3-29 AnGap-9\n___ 12:16PM BLOOD calTIBC-147* Ferritn-90 TRF-113*\n___ 02:06AM BLOOD TSH-7.8*\n___ 12:27AM BLOOD Free T4-0.89*\n___ 06:15AM BLOOD Cortsol-9.5\n___ 05:22AM BLOOD tacroFK-6.7\nMr. ___ is a ___ gentleman with a history of CVA with \nresidual right sided hemiparesis, type 1 diabetes, renal \ntransplant (cadaveric in ___ on tacrolimus, CAD s/p CABG, v \nfib arrest with anoxic brain injury (___), h/o recurrent \naspiration pneumonia, tracheomalacia s/p tracheostomy, and \nrecent ICU admission for hypotension and pneumonia, sent to the \nED from home after ___ found sodium to be 122. Na was 133 on \ndischarge on ___. \nHospital course:\n\n# Hyponatremia: He was initially admitted to the ICU. \nDifferential included hypovolemic hyponatremia, likely from \nincreased lasix use vs. hypervolemic hyponatremia in the setting \nof CHF and anasarca. Urine lytes showed a very low FeNA, \nsuggesting that hypovolemia was the most likely cause. The \npatient's Na was corrected very slowly with hypertonic saline. \nAt the time of ICU call out Na had improved from 117 on \nadmission to 134. After transfer to the floor, his sodium again \ndropped with decreased tube feeds and decreased normal saline. \nWith IV fluids, he would again improve, arguing for hypovolemia. \n By the time of discharge, he had stable sodium for 3 days, \nabove 130. Discharged at 135.\n\n# Acute encephalopathy: Likely explained by significant \nhyponatremia (see below), with no infection identified. \nInfectious workup included blood cultures and urinalysis were \nnegative. At the time of discharge, mental status appeared close \nto recent baseline.\n\n# S. aeruginosa cellulitis: The patient was continued on his \nregimen of 6 weeks ciprofloxacin/metronidazole to finish ___. \n He did develop drainage from his left great toe, which podiatry \ndebrided on ___ and ___, prior to discharge. Betadine \ndressings to the open areas on the feet were recommended.\n\n# Anemia: Hct 23.1 down from 26.4 on discharge. Blood pressures \nare stable. Hematocrit was at 24 on discharge. He had no \nevidence of acute blood loss.\n\n# Type 1 diabetes: He was continued on insulin, but ___ was \nconsulted for hypoglycemia. Home NPH was decreased from 6 units \nto 4 units in the morning breakfast, and 1 unit from 2 units \nqhs, humalog sliding scale. His HgbA1c was 5.7. ___ \nrecommended follow up as possible.\n\n# Chronic systolic CHF: He developed intermittent lower \nextremity, penile, facial and scrotal edema. He had effective \ndecreased edema with 40 mg of po furosemide, and this was \nrecommended at discharge.\n\n=======================================\nINACTIVE/CHRONIC ISSUES\n=======================================\n# Hx Cadaveric Renal Transplant ___: continued tacrolimus, \nprednisone and dapsone. Tacro level was therapeutic, per renal \ntransplant.\n\n# s/p CVA with residual right hemiparesis: at baseline.\n\n# CAD s/p CABG and EF 35%: on ASA, pravastatin, lasix at home. \nLasix was held in the ICU given his hyponatremia. \n\n# Tracheomalacia s/p tracheostomy and recurrent aspiration PNA: \nOn albuterol at home, has suction equipment and 24-hour care. \nContinued respiratory care in the ICU.\n\n# psych: continued fluvoxamine, quetiapine \n\n# Hypothyroidism: continued levothyroxine. TSH was high at 7.6, \nbut FT 4 was slightly low at 0.89. Repeat TFTs are recommended \nin 4 weeks.\n\n# Goals of care\nDiscussed goals in detail with daughter and wife on this \nadmission - they are not interested in hospice. They are sad \nabout his recent decline, which has been very notable over the \npast several months. They ask repeatedly what will happen if \nhis sodium goes down again - and I told them that they could \nbring him back to the hospital if they want, or they could also \nkeep him at home. I told them that I anticipated that he would \nnot improve significantly, that he was at risk for recurrent \nhospitalizations, and that I anticipated his prognosis to be in \nmonths.\n\n=======================================\nTRANSITIONAL ISSUES\n=======================================\n# Communication: ___, wife/HCP: cell- ___, Home- \n___ ___ - ___\n# Code: DNR/DNI (has trach)\n\nRepeat TFTs are recommended in 4 weeks.\nRepeat BMP on ___ or ___ of next week.\nContinued discussion of goals of care"}}
|
{'final_diagnoses': ['Hyponatremia', 'Encephalopathy', 'Type I diabetes mellitus, with complications', 'Likely osteomyelitis and cellulitis of feet', 'Chronic anemia', 'Chronic diastolic CHF'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ gentleman with a history of CVA with \nresidual right sided hemiparesis, type 1 diabetes, renal \ntransplant (cadaveric in ___ on tacrolimus, CAD s/p CABG, v \nfib arrest with anoxic brain injury (___), h/o recurrent \naspiration pneumonia, tracheomalacia s/p tracheostomy, and \nrecent ICU admission for hypotension and pneumonia, sent to the \nED from home after ___ found sodium to be 122. Na was 133 on \ndischarge on ___. \nHospital course:\n\n# Hyponatremia: He was initially admitted to the ICU. \nDifferential included hypovolemic hyponatremia, likely from \nincreased lasix use vs. hypervolemic hyponatremia in the setting \nof CHF and anasarca. Urine lytes showed a very low FeNA, \nsuggesting that hypovolemia was the most likely cause. The \npatient's Na was corrected very slowly with hypertonic saline. \nAt the time of ICU call out Na had improved from 117 on \nadmission to 134. After transfer to the floor, his sodium again \ndropped with decreased tube feeds and decreased normal saline. \nWith IV fluids, he would again improve, arguing for hypovolemia. \n By the time of discharge, he had stable sodium for 3 days, \nabove 130. Discharged at 135.\n\n# Acute encephalopathy: Likely explained by significant \nhyponatremia (see below), with no infection identified. \nInfectious workup included blood cultures and urinalysis were \nnegative. At the time of discharge, mental status appeared close \nto recent baseline.\n\n# S. aeruginosa cellulitis: The patient was continued on his \nregimen of 6 weeks ciprofloxacin/metronidazole to finish ___. \n He did develop drainage from his left great toe, which podiatry \ndebrided on ___ and ___, prior to discharge. Betadine \ndressings to the open areas on the feet were recommended.\n\n# Anemia: Hct 23.1 down from 26.4 on discharge. Blood pressures \nare stable. Hematocrit was at 24 on discharge. He had no \nevidence of acute blood loss.\n\n# Type 1 diabetes: He was continued on insulin, but ___ was \nconsulted for hypoglycemia. Home NPH was decreased from 6 units \nto 4 units in the morning breakfast, and 1 unit from 2 units \nqhs, humalog sliding scale. His HgbA1c was 5.7. ___ \nrecommended follow up as possible.\n\n# Chronic systolic CHF: He developed intermittent lower \nextremity, penile, facial and scrotal edema. He had effective \ndecreased edema with 40 mg of po furosemide, and this was \nrecommended at discharge.\n\n=======================================\nINACTIVE/CHRONIC ISSUES\n=======================================\n# Hx Cadaveric Renal Transplant ___: continued tacrolimus, \nprednisone and dapsone. Tacro level was therapeutic, per renal \ntransplant.\n\n# s/p CVA with residual right hemiparesis: at baseline.\n\n# CAD s/p CABG and EF 35%: on ASA, pravastatin, lasix at home. \nLasix was held in the ICU given his hyponatremia. \n\n# Tracheomalacia s/p tracheostomy and recurrent aspiration PNA: \nOn albuterol at home, has suction equipment and 24-hour care. \nContinued respiratory care in the ICU.\n\n# psych: continued fluvoxamine, quetiapine \n\n# Hypothyroidism: continued levothyroxine. TSH was high at 7.6, \nbut FT 4 was slightly low at 0.89. Repeat TFTs are recommended \nin 4 weeks.\n\n# Goals of care\nDiscussed goals in detail with daughter and wife on this \nadmission - they are not interested in hospice. They are sad \nabout his recent decline, which has been very notable over the \npast several months. They ask repeatedly what will happen if \nhis sodium goes down again - and I told them that they could \nbring him back to the hospital if they want, or they could also \nkeep him at home. I told them that I anticipated that he would \nnot improve significantly, that he was at risk for recurrent \nhospitalizations, and that I anticipated his prognosis to be in \nmonths.\n\n=======================================\nTRANSITIONAL ISSUES\n=======================================\n# Communication: ___, wife/HCP: cell- ___, Home- \n___ ___ - ___\n# Code: DNR/DNI (has trach)\n\nRepeat TFTs are recommended in 4 weeks.\nRepeat BMP on ___ or ___ of next week.\nContinued discussion of goals of care", 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H', '2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB', '3. Aspirin 81 mg PO DAILY', '4. Ciprofloxacin HCl 250 mg PO Q12H \nThrough ___', '5. Dapsone 25 mg PO 3X/WEEK (___)', '6. Ferrous Sulfate (Liquid) 300 mg PO DAILY \nIron should be given separate from the ciprofloxacin and the \ncalcium.', '7. Fluvoxamine Maleate 50 mg PO BID', '8. Guaifenesin 5 mL PO Q4H:PRN cough', '9. NPH 4 Units Breakfast\nNPH 1 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', '10. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY', '11. Levothyroxine Sodium 37.5 mcg PO DAILY', '12. MetRONIDAZOLE (FLagyl) 500 mg PO TID \nThrough ___', '13. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '14. Pravastatin 80 mg PO DAILY', '15. PredniSONE 4 mg PO DAILY', '16. QUEtiapine Fumarate 25 mg PO Q6H:PRN agitation', '17. Tacrolimus Suspension 3 mg PO BID', '18. Zinc Sulfate 220 mg PO DAILY', '19. Clotrimazole Cream 1 Appl TP BID', '20. Furosemide 40 mg PO EVERY ___ DAY PRN swelling \nRX *furosemide 40 mg 1 tablet(s) by mouth every ___ day Disp \n#*15 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 20, 'gender': 'F', 'symptoms': 'Bright red blood per rectum', 'medical_history': ['multiple medication intolerances', 'breast CA s/p resection and XRT, did not tolerate anti \nestrogens', 'R hemithyroidectomy and L thyroid nodules', 'hypothyroid', 'hyperfibrinolysis syndrome. Gets aminocaproic acid before\nsurgeries.', 'IgG subclass deficiency, seen allergy in past', 'CKD stage II/III', 'osteoporosis', 'uterine CA s/p hysterectomy', 'anal SCC in situ and anal papillomas', 'IBS, GERD', 'chronic fatigue, fibromyalgia', 'numbness, prior EMG in ___ c/w "chronic mild sensorimotor\npolyneuropathy."', 'hx of skin abscesses/furuncles', 'sebaceous cysts on scalp'], 'family_history': 'Father - multiple myeloma, died age ___ \nMother - living, age ___ atrial fibrillation \nBrother - arthritis \nSister - arthritis \nNo children \nNo family history of significant allergic or infectious \nconditions: according to the patient, IgG subclass deficiency \nand hyperfibrionlysis all started ___ years ago.', 'present_illness': "Ms. ___ is a ___ female with IBS, internal \nhemorrhoids, and fibrinolysis syndrome who presented with \ndiarrhea and bright red blood per rectum.\n\nShe reports that had a rice cake and a little butter around \nmidnight on ___ night; after that she started to have \nabdominal cramping and diarrhea ___ times on ___ morning). \nTypically she goes about a week between significant bowel \nmovements. She also started to have itching and nausea without \nvomiting. In the afternoon she started to pass small amounts of \nbright red blood about ___ times. She felt that this was not \nconsistent with prior bleeding from her internal hemorrhoid. She \nwas feeling very cold. No fevers. She also had LLQ pain. She \ncalled her PCP's office and she decided to come in. \n\nCurrently, her pain is improved but she is still having LLQ pain \nwhich wraps around to back. She has been feeling nauseated on \nand off. No vomiting. She continues to pass bright red blood per \nrectum in the hospital ___ times). She is not feeling as \nlightheaded or dizzy since she came to the hospital. No chest \npain or shortness of breath.", 'medications': [{'medication': 'Mesalamine Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'QHS', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H: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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mesalamine Enema', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mesalamine DR', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, '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': '13.8', 'valuenum': 13.8, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, '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': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, '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': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.9, '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': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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}], 'exams': 'ADMISSION EXAM:\nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, PERRL\nENT: MMM, OP clear\nCV: NR/RR, no m/r/g\nRESP: CTAB\nGI: Abdomen soft, non-distended, TTP in LLQ and epigastrium \nwithout guarding or rebound tenderness. Bowel sounds present. \nNo HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities\nVASC: 1+ pitting edema in ___ bilaterally\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI, speech fluent, moves all limbs\nPSYCH: pleasant, appropriate affect', 'diagnoses': [{'icd_code': '5569', 'desc': 'Ulcerative colitis, unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4550', 'desc': 'Internal hemorrhoids without mention of complication'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '6253', 'desc': 'Dysmenorrhea'}, {'icd_code': 'V1859', 'desc': 'Family history of other digestive disorders'}], 'summary': "LABS:\n___ 08:45PM BLOOD WBC-5.2 RBC-4.22 Hgb-12.9 Hct-39.9 MCV-95 \nMCH-30.6 MCHC-32.3 RDW-13.5 RDWSD-46.8* Plt ___\n___ 01:10PM BLOOD WBC-5.4 RBC-4.04 Hgb-12.5 Hct-38.7 MCV-96 \nMCH-30.9 MCHC-32.3 RDW-13.3 RDWSD-47.3* Plt ___\n___ 05:39AM BLOOD Plt ___\n___ 01:10PM BLOOD Plt ___\n___ 05:38AM BLOOD WBC-4.3 RBC-3.42* Hgb-10.5* Hct-32.5* \nMCV-95 MCH-30.7 MCHC-32.3 RDW-13.2 RDWSD-45.5 Plt ___\n___ 06:22AM BLOOD Glucose-70 UreaN-14 Creat-1.0 Na-146 \nK-4.1 Cl-107 HCO3-25 AnGap-14\n\nIMAGING:\nCT abd: Short-segment sigmoid colitis. Otherwise unremarkable \nCT.\n\nMICRO:\n#STOOL VIRAL MOLECULAR NoroGI NoroGII \n___ 12:30 NEGATIVE1 NEGATIVE2 \nSource: Stool \n\n1.NEGATIVE\nGENOGROUP I - TEST PERFORMED BY PCR\n2.NEGATIVE\nGENOGROUP II - TEST PERFORMED BY PCR\n\n#Fecal CMV PCR (qual) - negative\n___ female with IBS, internal hemorrhoids, and \nhyperfibrinolysis who presented with diarrhea and bright red \nblood per rectum.\n\nACUTE/ACTIVE PROBLEMS:\n# BRBPR \nHistory of internal hemorrhoids suggests a possible source. No \nhemorrhoids visualized on GI's rectal exam. LGIB ___ \ndiverticular bleed possible, but no diverticula visualized on CT \nabd/pelvis. Mild sigmoid colon inflammation present. She had no \npreceding illness/diminished PO intake to suggest a low flow \nstate precipitated ischemic colitis. Given the onset of symptoms \nafter eating lactose, her lactose intolerance is a \nconsideration, but passage of BRBPR is not consistent with this. \nLow concern for UGIB given her hemodynamic stability. GI was \nconsulted to address these concerns. We had multiple attempts at \ngetting stool sample which were unsuccessful (pt unable to make \nsufficient quantity each time and had difficulty with actual \nmethod of collection) therefore she underwent flexible \nsigmoidoscopy on ___ with biopsies taken of area of inflammation \nin sigmoid colon as well as from multiple anal condyloma that \nwere found. At the time of discharge, the norovirus and CMV were \nnegative, other biopsy results pending. GI was concerned that \nthe colitis could represent progression of patient's immune \ndeficiency to CVID therefore recommended checking \nimmunoglobulins and IgG sublasses, which are also pending at \ntime of discharge.\n\n#Hyperfibrinolysis:\nShe was started on ___ on admission given report of GI \nbleeding however after one dose she felt that this was causing \nher more mucous and diarrhea. She was no longer clinically \nbleeding and Hgb stable so this was stopped. In order to get the \nflex sig with biopsies as above, she was restarted on Amicar as \nhas been protocoled by her outpatient heme notes: 1g x1 prior to \nflex sig, with continuation of 1g PO every 4 hours for the first \n24 hours then increased frequency to every 6 hours to complete \ntotal of 3 days of Amicar. This was not finished at time of \ndischarge therefore patient was given prescription for Amicar. \nShe was also given prescription for Zofran for intermittent \nnausea.\n\n#Mild thrombocytopenia: Plt down to 114 during admission. \nUnclear why, this is a potential side effect of Amicar therefore \nI recommended to patient that she f/u with PCP after off ___ \nto see if they resolved. Also potential side effect of yet \nunidentified virus that could have been causing her symptoms."}}
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{'final_diagnoses': ['Lower GI bleed', 'Hyperfibrinolysis'], 'procedures': ['Flexible sigmoidoscopy ___'], 'visit_summary': "___ female with IBS, internal hemorrhoids, and \nhyperfibrinolysis who presented with diarrhea and bright red \nblood per rectum.\n\nACUTE/ACTIVE PROBLEMS:\n# BRBPR \nHistory of internal hemorrhoids suggests a possible source. No \nhemorrhoids visualized on GI's rectal exam. LGIB ___ \ndiverticular bleed possible, but no diverticula visualized on CT \nabd/pelvis. Mild sigmoid colon inflammation present. She had no \npreceding illness/diminished PO intake to suggest a low flow \nstate precipitated ischemic colitis. Given the onset of symptoms \nafter eating lactose, her lactose intolerance is a \nconsideration, but passage of BRBPR is not consistent with this. \nLow concern for UGIB given her hemodynamic stability. GI was \nconsulted to address these concerns. We had multiple attempts at \ngetting stool sample which were unsuccessful (pt unable to make \nsufficient quantity each time and had difficulty with actual \nmethod of collection) therefore she underwent flexible \nsigmoidoscopy on ___ with biopsies taken of area of inflammation \nin sigmoid colon as well as from multiple anal condyloma that \nwere found. At the time of discharge, the norovirus and CMV were \nnegative, other biopsy results pending. GI was concerned that \nthe colitis could represent progression of patient's immune \ndeficiency to CVID therefore recommended checking \nimmunoglobulins and IgG sublasses, which are also pending at \ntime of discharge.\n\n#Hyperfibrinolysis:\nShe was started on ___ on admission given report of GI \nbleeding however after one dose she felt that this was causing \nher more mucous and diarrhea. She was no longer clinically \nbleeding and Hgb stable so this was stopped. In order to get the \nflex sig with biopsies as above, she was restarted on Amicar as \nhas been protocoled by her outpatient heme notes: 1g x1 prior to \nflex sig, with continuation of 1g PO every 4 hours for the first \n24 hours then increased frequency to every 6 hours to complete \ntotal of 3 days of Amicar. This was not finished at time of \ndischarge therefore patient was given prescription for Amicar. \nShe was also given prescription for Zofran for intermittent \nnausea.\n\n#Mild thrombocytopenia: Plt down to 114 during admission. \nUnclear why, this is a potential side effect of Amicar therefore \nI recommended to patient that she f/u with PCP after off ___ \nto see if they resolved. Also potential side effect of yet \nunidentified virus that could have been causing her symptoms.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q4H:PRN Pain - Mild ', 'Aminocaproic Acid 5 g PO ONCE ', 'calcium citrate 250 mg calcium oral Frequency is Unknown ', 'ClonazePAM 1 mg PO QHS ', 'EpiPen (EPINEPHrine) 0.3 mg/0.3 mL injection once \nanaphylaxis ', 'levothyroxine 75 mcg oral 6X/WEEK (___) ', 'levothyroxine 100 mcg oral 1X/WEEK (SA) ', 'Mupirocin Ointment 2% 1 Appl NU BID ', 'nystatin 100,000 unit/gram topical BID ', 'Tinactin (tolnaftate) 1 % topical 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': 72, 'gender': 'F', 'symptoms': 'Fever and mental status changes.', 'medical_history': ['ONCOLOGIC HISTORY:', '# Rectal cancer:', '- late ___: 6 months of intermittent rectal bleeding, rectal\npressure and a sensation of incomplete emptying. ', '- ___: colonoscopy revealed a polyp in her sigmoid colon and\na 2.5 cm distal rectal mass arising from the anal verge in the\nposterior rectum with a large area of induration. ', '- ___: CT torso revealed an exophytic rectal mass measuring\n4.8 x 3.8 cm, bulging posteriorly into the presacral space and\nanteriorly towards the uterus. There were enlarged lymph nodes \nin\nthe perirectal fat adjacent to the mass, a 9-mm enhancing lymph\nnode in the left pelvic sidewall, and enhancing lymph nodes in\nthe right external iliac region. There was also a 7-mm\nhypodensity in the caudate lobe of the liver. Rectal ultrasound\non ___ and rectal MRI on ___ were compatible with T3\ndisease. There were at least four abnormal perirectal lymph \nnodes\nseen on MRI, in addition to multiple bilateral enlarged pelvic\nsidewall lymph nodes, concerning for extensive disease. ', '- ___: began chemoradiation', '- ___: ___ was discontinued due to mucositis, neutropenia,\nand abdominal cramping', '- ___: ___ was restarted at a reduced dose', '- ___: ___ was again stopped due to mucositis, perirectal\nskin changes, diarrhea, and electrolyte abnormalities. ', '- ___: Radiation was also held ', '- ___: ___ was restarted at a further reduced dose', '- ___: completed radiation ', '- ___: completed chemotherapy ', '- ___: hospitalized for bowel rest and the \ninitiation\nof TPN due to presumed radiation enteritis. ', '- ___: found to be HIV positive and began on HAART', '- ___: required hospitalization for an SBO, underwent\nlaparotomy, ileocecectomy, end-ileostomy, and placement of a\n___ tube on ___. Pathology from this surgery revealed \nsevere\nradiation-induced acute ischemic enteritis. She recovered from\nthis surgery, but continued to require TPN. ', '- ___: Once her CD4 count had recovered, she underwent\nlaparotomy, lysis of adhesions, ileal resection,\nproctosigmoidectomy, colonic jejunal pouch to near-anal\nanastomosis with EEA, takedown splenic flexure, resection of\nileostomy and creation of new end-ileostomy. Pathology from the\nsurgical specimen revealed no residual carcinoma and all 14 \nlymph\nnodes sampled were free of disease. ', '- ___: Subsequent imaging of the abdomen & pelvis\nshowed no evidence of recurrence. ', '- ___: CT abdomen showed "hyperdense thickening in the lumen\nnear the anastomatic site, new since the earlier study. Local\nrecurrence cannot be excluded, although possibly the appearance\nis associated with endoluminal debris."', 'OTHER MEDICAL HISTORY:', '# HIV.', '# Short gut syndrome secondary to bowel surgery for CA.', '# Obstructive renal failure from radiation fibrosis, in the past \nnecessitating b/l nephrostomy tubes.', '# Lower extremity neuropathy, likely secondary to radiation \nfibrosis, uses a wheelchair since ___.', '# Pancreatic insufficiency.', '# Anemia.', '# Chronic pain.', '# LLE DVT: dx ___, on warfarin.'], 'family_history': 'Father died at ___ of MI. Mother alive and well. Remote history \nof\nbreast, colon cancer. Daughter has UC.', 'present_illness': '___ yo woman with a h/o recatal ca s/p chemoXRT complicated by \nradiation enteritis/fibrosis/neuropathy and HIV, presenting with \nfevers, elevated WBC, and mental status changes. Pt was \ndischarged ___ after hospitalization for recurrent partial \nSBO, which was treated conservatively. During that \nhospitalization, she developed fevers and was found to have a \nLLL infiltrate. She was treated with vanco and cefepime for \nhospital-acquired pneumonia and completed the course with home \nIV, finishing yesterday. Last two doses of vancomycin were held \nbecause of an elevated trough of 29. Since discharge, she has \nhad one episode of bowel obstruction, which resolved after \nseveral hours. However, over the past 4 days, she has had low \ngrade fevers with mental status changes. Outside WBC count was \nreportedly 18. She notes a productive cough.\nHistory mainly per husband, as patient fell asleep throughout \nthe interview. She denies headaches, photophobia, neck \nstiffness, mouth pain, flank pain/ back pain,nausea, vomiting, \ndyspnea, chest pain, and palpitations. All other ten review of \nsystems is negative.', 'medications': [{'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nephrocaps', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', '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': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'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': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, '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}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, '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': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, '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': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '27', 'valuenum': 27.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\nGeneral: Pt lethargic but easily arousable and able to follow \ncommands and answer questions.\nVitals: T 97 BP 100/88 RR 18 Os sat 99% RA\nHEENT: anicteric,pupils dilated but reactive,o/p clear, mmm\nNeck: supple, no nuchal rigidity, no thyromegaly, no cervical \nLAD\nLungs: Bibasilar crackles\nCV: RRR, no murmurs, rubs /gallops\nAbdomen; Ileostomy in place, soft and non-tender\nBack: bilateral nephrostomies, no flank tenderness\nExt: bilateral edema, left>right\nNeuro: Lethargic but arousable and then oriented,upper extremity \nstrength ___ , lower extremity -chronic weakness, tongue \nmid-line, no pronator drift.', 'diagnoses': [{'icd_code': '5722', 'desc': 'Hepatic encephalopathy'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '7845', 'desc': 'Speech disturbance nec'}, {'icd_code': '59972', 'desc': 'Microscopic hematuria'}, {'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': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '44389', 'desc': 'Other specified peripheral vascular diseases'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '43819', 'desc': 'Late effects of cerebrovascular disease, other speech and language deficits'}, {'icd_code': 'V1588', 'desc': 'History of fall'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': 'ADMISSION LABS:\n___ 04:04PM GLUCOSE-124* UREA N-20 CREAT-1.1 SODIUM-136 \nPOTASSIUM-4.2 CHLORIDE-102 TOTAL CO2-29 ANION GAP-9\n___ 04:04PM ALT(SGPT)-11 AST(SGOT)-9 LD(LDH)-90* ALK \nPHOS-143* TOT BILI-0.1\n___ 04:04PM ALBUMIN-2.5* CALCIUM-8.0* PHOSPHATE-2.2* \nMAGNESIUM-1.7\n___ 04:04PM WBC-8.3 RBC-3.63* HGB-10.7* HCT-32.7* MCV-90 \nMCH-29.5 MCHC-32.8 RDW-16.8*\n___ 04:04PM NEUTS-73.9* ___ MONOS-4.3 EOS-1.8 \nBASOS-0.6\n___ 04:04PM PLT COUNT-252\n.\nCXR ___: improved aeration at the left base with \nnear-complete resolution of the previous pneumonia and only \nseveral residual streaks of atelectasis. Hazy opacification at \nthe right base persists, most likely related to atelectasis. \nHowever, in the appropriate clinical setting, pneumonia can \ncertainly not be excluded.\n.\nKUB ___: IMPRESSION: Nonspecific bowel gas pattern \nsuggestive of paralytic ileus or small bowel obstruction. air \nfluid levels.\n.\nDISCHARGE LABS:\n___ 05:50AM BLOOD VitB12-838 Folate-14.5\n___ 05:52AM BLOOD Vanco-14.8\n___ 05:20AM BLOOD WBC-6.4 RBC-3.39* Hgb-9.7* Hct-30.6* \nMCV-90 MCH-28.6 MCHC-31.7 RDW-17.0* Plt ___\n___ 05:20AM BLOOD ___ PTT-26.2 ___\n___ 05:20AM BLOOD Glucose-78 UreaN-7 Creat-0.6 Na-136 \nK-3.2* Cl-101 HCO3-30 AnGap-8\n___ 05:20AM BLOOD Calcium-7.6* Phos-2.5* Mg-1.\n___ yo woman with h/o rectal ca s/p chemoXRT currently ___, with \nmultiple complications from the XRT and HIV admitted with mental \nstatus changes and fevers s/p a recent hospitalization for \npartial SBO.\n.\n# Fever: Pt reportedly had fevers at home and an elevated WBC \ncount. On admission pt was afebrile anD remained afebrile. Her \nwbc count was also normal. Given the initial concern of an \ninfectious process in the setting of MS changes, she was started \non meropenem and blood, urine, and stool cultures were obtained, \nbut remained negative. She remained aferile and mental status \nimproved without any source of infection. In consultation with \nthe Infectious Disease service, antibiotics were discontinued.\n.\n# Mental status changes: Attributed to medications: Methadone, \nhydromorphone, lorazepam, pregabalin, mirtazapine, and \ncarbamezapine. Methadone, pregabalin, mirtazipine, and \ncarbamezapine were held for the first 24 hrs and as her mental \nstatus improved, methadone was re-introduced. According to the \nhusband, her doses have not recently changed and documented dose \nadjustments, such as increasing methadone to ___ \nalternating doses q6hr and pregabalin to 200mg BID, were never \ninstituted at home. Mental status waxed and waned depending on \nIV narcotics and lorazepam and improved with med changes: \nanti-emetics including lorazepam changed to prn; stopped \nhyoscyamine (anticholinergic); stopped carbamezapine; \nreintroduce pregabalin at low dose 50mg TID.\n.\n# HIV: Last CD4 count ___ was 300. HAART was continued as \nprescribed previously. CD4 level was ordered and viral load \nremained low.\n.\n# Small bowel obstruction: On day 2 of admission she started to \ndevelop nausea/vomiting and abdominal pain with a decrease in \nostomy output. KUB showed evidence of a SBO. GI, ERCP, and \nColorectal Surgery were consulted, but all services felt that \nintervention was too risky (stenting and risk of perforation). \nEventually, her symptoms resolved without intervention and her \nlow-residue diet was advanced to soft.\n.\n# Coagulapathy (INR 5.8): Coagulopathy was a result of warfarin, \nrecent antibiotics (interaction?), and poor nutrition. It \nresolved after stopping warfarin and giving vitamin K. Warfarin \nwill not be restarted as she has completed 8 months of treatment \nfor a DVT, which was possibly provoked by EPO. EPO was also \nstopped.\n.\n# Pain Management: Continued outpatient methadone and prn \ndilaudid q2hrs. Initially held for mental status changes, \npregabalin was restarted at low dose 50mg TID and increased to \n100mg BID. Carbamezapine was stopped and not restarted. The \nPain service and Palliative were both consulted.\n.\n# FEN: When the small bowel obstruction recurred, she was made \nNPO. As her symptoms resolved, her diet was advanced to soft, \nlow residue. She was given IV fluids and electrolytes were \nrepleted for hypomagnesemia and hypophosphatemia.\n.\n# DVT Prophylaxis: Initially coagulopathic on warfarin. When \nthe coagulopathy resolved, SC heparin was started.\n.\nPrecautions: Fall.\n.\nLines: Port.\n.\nCODE: FULL.'}}
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{'final_diagnoses': ['1. Fever.', '2. Mental status changes.', '3. Small bowel obstruction.', '4. Coagulopathy (overly thinned blood from warfarin).', '5. HIV.', '6. Peripheral neuropathy.'], 'procedures': ['None.'], 'visit_summary': '___ yo woman with h/o rectal ca s/p chemoXRT currently ___, with \nmultiple complications from the XRT and HIV admitted with mental \nstatus changes and fevers s/p a recent hospitalization for \npartial SBO.\n.\n# Fever: Pt reportedly had fevers at home and an elevated WBC \ncount. On admission pt was afebrile anD remained afebrile. Her \nwbc count was also normal. Given the initial concern of an \ninfectious process in the setting of MS changes, she was started \non meropenem and blood, urine, and stool cultures were obtained, \nbut remained negative. She remained aferile and mental status \nimproved without any source of infection. In consultation with \nthe Infectious Disease service, antibiotics were discontinued.\n.\n# Mental status changes: Attributed to medications: Methadone, \nhydromorphone, lorazepam, pregabalin, mirtazapine, and \ncarbamezapine. Methadone, pregabalin, mirtazipine, and \ncarbamezapine were held for the first 24 hrs and as her mental \nstatus improved, methadone was re-introduced. According to the \nhusband, her doses have not recently changed and documented dose \nadjustments, such as increasing methadone to ___ \nalternating doses q6hr and pregabalin to 200mg BID, were never \ninstituted at home. Mental status waxed and waned depending on \nIV narcotics and lorazepam and improved with med changes: \nanti-emetics including lorazepam changed to prn; stopped \nhyoscyamine (anticholinergic); stopped carbamezapine; \nreintroduce pregabalin at low dose 50mg TID.\n.\n# HIV: Last CD4 count ___ was 300. HAART was continued as \nprescribed previously. CD4 level was ordered and viral load \nremained low.\n.\n# Small bowel obstruction: On day 2 of admission she started to \ndevelop nausea/vomiting and abdominal pain with a decrease in \nostomy output. KUB showed evidence of a SBO. GI, ERCP, and \nColorectal Surgery were consulted, but all services felt that \nintervention was too risky (stenting and risk of perforation). \nEventually, her symptoms resolved without intervention and her \nlow-residue diet was advanced to soft.\n.\n# Coagulapathy (INR 5.8): Coagulopathy was a result of warfarin, \nrecent antibiotics (interaction?), and poor nutrition. It \nresolved after stopping warfarin and giving vitamin K. Warfarin \nwill not be restarted as she has completed 8 months of treatment \nfor a DVT, which was possibly provoked by EPO. EPO was also \nstopped.\n.\n# Pain Management: Continued outpatient methadone and prn \ndilaudid q2hrs. Initially held for mental status changes, \npregabalin was restarted at low dose 50mg TID and increased to \n100mg BID. Carbamezapine was stopped and not restarted. The \nPain service and Palliative were both consulted.\n.\n# FEN: When the small bowel obstruction recurred, she was made \nNPO. As her symptoms resolved, her diet was advanced to soft, \nlow residue. She was given IV fluids and electrolytes were \nrepleted for hypomagnesemia and hypophosphatemia.\n.\n# DVT Prophylaxis: Initially coagulopathic on warfarin. When \nthe coagulopathy resolved, SC heparin was started.\n.\nPrecautions: Fall.\n.\nLines: Port.\n.\nCODE: FULL.', 'medications_prescribed': ['1. ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily). ', '2. darunavir 400 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '3. abacavir-lamivudine 600-300 mg Tablet Sig: One (1) Tablet PO \nonce a day. ', '4. methadone 10 mg Tablet Sig: One (1) Tablet PO Q6HR ().\nDisp:*84 Tablet(s)* Refills:*0*', '5. hydromorphone 4 mg Tablet Sig: ___ Tablets PO q3hr as needed \nfor pain.\nDisp:*50 Tablet(s)* Refills:*0*', '6. pregabalin 100 mg Capsule Sig: One (1) Capsule PO twice a \nday. ', '7. lorazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime as \nneeded for insomnia. ', '8. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime) as needed for insomnia. ', '9. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) \nas needed for insomnia. ', '10. ondansetron HCl 4 mg Tablet Sig: ___ Tablets PO every eight \n(8) hours as needed for nausea. ', '11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '12. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '13. Vitamin B-12 1,000 mcg Tablet Sig: One (1) Tablet PO once a \nday. ', '14. magnesium oxide 400 mg Tablet Sig: Two (2) Tablet PO twice a \nday. Tablet(s) ', '15. multivitamin 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': 63, 'gender': 'M', 'symptoms': 'right foot pain, elevated creatinine', 'medical_history': ['- CAD: 3 vessel disease, previously recommended for CABG', '- Diastolic CHF', '- chronic descending aortic dissection', '- ESRD s/p transplant ___', '- HTN', '- COPD', '- GERD', '- moderate pulm HTN', '- s/p TAH/BSO', '- s/p appendectomy', '- s/p ventral hernia repair ___'], 'family_history': 'Noncontributory.', 'present_illness': '___ y/o female with PMHx of CKD, renal txp, CAD, dCHF, COPD with \nrecent admission for diverticulitis presents with acute on \nchronic kidney disease. \nOf note, the patient had a recent admission to ___ ___ thru \n___ for abdominal pain. She was treated for uncomplicated \ndiverticulitis. Her hospital course was complicated by acute on \nchronic renal failure (thought to be due to ATN), influenza \ninfection, ___ exacerbation (resulting in flash pulmonary \nedema), and troponinemia (troponin 0.08-0.13, with no MB bump, \nno EKG changes, thought to be demand ischemia in the setting of \nflash pulmonary edema). Of note, it was recommended that the \npatient be discharged to rehab, however she declined this. \nSince discharge, the patinet has been followed by PACT. Per OMR, \npatient developed difficulty ambulating at home due to right \nfoot pain and has not been eating/drinking. She reports that she \ndrinks ___ ensures daily, but otherwise does not have much of an \nappetite and does not wish to eat. She presented to follow-up \n(seen by Dr. ___, where labs were notable for worsening \nrenal function with Cr 3.7 (2.3 on discharge) for which she was \nreferred to the ED for likely medicine. She reports that she was \nfeeling fine, but she came to the ED because she was told she \nwas dehydrated. In terms of her right foot pain, she reports \nthat there is worsening ___ sharp right foot pain on the top \nof her foot to her toes and ankles. She denies any trauma, \nfevers, chills, nausea, vomiting. \nUpon arrival to ___ ED, initial VS 97.2 60 127/52 18 97% RA. \nLabs notable for Chem-7 with BUN/Cr 57/3.7, LFTs wnl, CBC with \nH/H 7.2/22.4 (Hct 23 on ___ discharge). R Foot X-ray and CXR \nconducted (both reads pending). EKG with sinus 63, no STE, qtc \n487. VS prior to transfer 65 125/48 16 99% RA \nOn the floor, she reports ___ right foot pain.', 'medications': [{'medication': 'Metoprolol Tartrate', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS: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': 'Clopidogrel', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Prasugrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'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': '7.3', 'valuenum': 7.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 191.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', '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': '3.6', 'valuenum': 3.6, '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': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 341.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', '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': '___', 'valuenum': 89.0, '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': 0.29, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, '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': '231', 'valuenum': 231.0, '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': '3.95', 'valuenum': 3.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.66, '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': '31', 'valuenum': 31.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.92, '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': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, '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': '4.14', 'valuenum': 4.14, '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': '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': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.83, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': '==============\nADMIT EXAM\n=============\nVitals - T:97.6 BP:139/42 HR:65 RR:18 02 sat:100%RA \nGENERAL: NAD, AOX3, lying flat in bed \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, Dry MM \nNECK: nontender supple neck, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, palpable transplanted kidney in LLQ nontender \n\nEXTREMITIES: no ___ edema noted \nTenderness to palpation over entire R foot including lateral and \nmedial malleous, not willing to attempt moving it. Cannot \npinpoint area of worsening tenderness \nNo right calf tenderness. \nPULSES: 2+ DP pulses bilaterally \nSKIN: stage II sacral ulcers \n\n==============\nDISCHARGE EXAM\n=============\nVital Signs: 98.8 50-70s 130s-150s/50-60s 16 100% on RA\nGeneral: Awake, alert, sitting up in bed, conversational\nHEENT: no tongue or lip swelling, sclera anicteric, oropharynx \nclear JVP not elevated\nLungs: clear to auscultation bilaterally, no murmurs, rubs\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops\nAbdomen: soft, non-tender, non-distended, transplanted kidney \npalpable in LLQ, scar from transplant surgery\nExt: Warm, perfused, weak pulses, no edema or erythema, no \ntenderness to palpation in feet bilaterally\nNeuro: A&Ox3, CN2-12 intact.\nSkin: stage II sacral ulcers.', 'diagnoses': [{'icd_code': '41011', 'desc': 'Acute myocardial infarction of other anterior wall, initial episode of care'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}], 'summary': '==============\nADMISSION LABS\n===============\n\n___ 12:47PM BLOOD WBC-7.7 RBC-2.25* Hgb-7.2* Hct-22.4* \nMCV-99* MCH-32.0 MCHC-32.2 RDW-16.9* Plt ___\n___ 12:47PM BLOOD UreaN-57* Creat-3.7*# Na-138 K-3.9 Cl-97 \nHCO3-23 AnGap-22*\n___ 12:47PM BLOOD ALT-4 AST-9 TotBili-0.3\n___ 12:47PM BLOOD Albumin-3.7 Calcium-8.2* Phos-6.0*#\n___ 12:47PM BLOOD tacroFK-15.4\n\n==============\nIMAGING\n===============\nRenal US ___: "Unremarkable, renal transplant ultrasound. \nNo change from ___\n\nCXR ___: "Minimal pulmonary vascular congestion, improved \nsince ___\n\nR Foot Xray ___: "Findings: There is no fracture involving \nthe right foot. The tarsal bones are normally aligned. The \nbones are diffusely demineralized. There are vascular \ncalcifications. \nImpression: No acute abnormality of the right foot."\n\nRenal US ___: IMPRESSION:Minimally elevated resistive \nindices in the lower pole of the transplant kidney, otherwise \nunremarkable. \n\nRenal US ___: "1. Interval improvement in peak velocity \nwith symmetric vascularity and resistive indices within the \nnormal range. No evidence of renal artery stenosis on this \nexamination. \n2. No hydronephrosis, perinephric collection or other \nsonographic abnormality involving the renal transplant graft."\n\n==============\nMICRO\n===============\n___ 8:46 am STOOL CONSISTENCY: LOOSE Source: \nStool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Illumigene DNA\n amplification assay. \n (Reference Range-Negative). \n\n___ 12:50 pm URINE Source: Catheter. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n ___ (TORULOPSIS) GLABRATA. >100,000 ORGANISMS/ML.. \n ___. ___ (___) REQUESTED YEAST SPECIATION \n___. \n\nBlood cultures ___- NGTD\n\n==============\nDISCHARGE LABS\n===============\n___ 06:50AM BLOOD WBC-5.2 RBC-2.53* Hgb-7.7* Hct-24.5* \nMCV-97 MCH-30.3 MCHC-31.4 RDW-19.7* Plt ___\n___ 06:50AM BLOOD Glucose-100 UreaN-57* Creat-2.5* Na-138 \nK-3.3 Cl-101 HCO3-25 AnGap-15\n___ 06:50AM BLOOD Calcium-9.1 Phos-3.0 Mg-1.___\nwith a history of CKD s/p renal transplant, ___, COPD who \nwas recently hospitalized for diverticulitis who presented with \nacute on chronic kidney failure (Cr elevated at 3.8 from 2.3 on \nprevious discharge) and right foot pain. She was started on IV \nfliuds to treat her ___, her torsemide was held. A renal \nultrasound was unremarkable. Her foot pain was treated with \noxycodone and pregabalin, which improved her symptoms. She \ndeveloped transient hypotension on ___ and was started on \nbroad-spectrum antibiotics including vancomycin, cefepime, and \nfluconazole. Her course was complicated by development of \nanaphylaxis on ___ requiring intubation and transfer to MICU. \nNew medications included vancomycin/fluconazole (which patient \nhad been exposed to during prior hospitalizations) and \ncefepime/pregabalin (which patient had not been exposed to in \nthe past). She was treated with benadryl, prednisone, and \nfamotidine, and was extubated and transferred back to the \nmedical floor. Her renal function improved to baseline and she \nwas transferred to rehab.'}}
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{'final_diagnoses': ['-anaphylaxis', '-acute kidney injury on chronic kidney disease'], 'procedures': ['-endotracheal intubation'], 'visit_summary': 'with a history of CKD s/p renal transplant, ___, COPD who \nwas recently hospitalized for diverticulitis who presented with \nacute on chronic kidney failure (Cr elevated at 3.8 from 2.3 on \nprevious discharge) and right foot pain. She was started on IV \nfliuds to treat her ___, her torsemide was held. A renal \nultrasound was unremarkable. Her foot pain was treated with \noxycodone and pregabalin, which improved her symptoms. She \ndeveloped transient hypotension on ___ and was started on \nbroad-spectrum antibiotics including vancomycin, cefepime, and \nfluconazole. Her course was complicated by development of \nanaphylaxis on ___ requiring intubation and transfer to MICU. \nNew medications included vancomycin/fluconazole (which patient \nhad been exposed to during prior hospitalizations) and \ncefepime/pregabalin (which patient had not been exposed to in \nthe past). She was treated with benadryl, prednisone, and \nfamotidine, and was extubated and transferred back to the \nmedical floor. Her renal function improved to baseline and she \nwas transferred to rehab.', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO DAILY pain', '2. Aspirin 81 mg PO DAILY', '3. Azathioprine 50 mg PO DAILY', '4. Carvedilol 25 mg PO BID', '5. Senna 8.6 mg PO BID:PRN constip', '6. Sodium Bicarbonate 650 mg PO BID', '7. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID', '8. Citalopram 20 mg PO DAILY', '9. Omeprazole 20 mg PO DAILY', '10. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation \nQ4H:PRN wheeze', '11. Docusate Sodium 100 mg PO BID:PRN Constipation', '12. Fluticasone Propionate NASAL 2 SPRY NU DAILY', '13. Nitroglycerin SL 0.3 mg SL PRN:WEEKLY chest pain', '14. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '15. Sodium Chloride Nasal 2 SPRY NU DAILY:PRN Dry nose', '16. Isosorbide Mononitrate (Extended Release) 60 mg PO QPM', '17. Aranesp (in polysorbate) (darbepoetin alfa in polysorbat) \n150 mcg/0.3 mL injection monthly', '18. Lidocaine 5% Patch 1 PTCH TD QAM', '19. Tiotropium Bromide 1 CAP IH DAILY', '20. Nicotine Patch 14 mg TD DAILY', '21. Cinacalcet 60 mg PO DAILY', '22. Torsemide 60 mg PO EVERY OTHER DAY', '23. Tacrolimus 1 mg PO Q12H']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 84, 'gender': 'M', 'symptoms': 'Dyspnea', 'medical_history': ['Infarct related CHF with prior EF 40-45%, but recovery to EF 50% \n___', 'CAD s/p CABG and revision in ___', 'Stage II CLL diagnosed in ___, stable with annual visits', 'DVT/PE, previously on warfarin, which was discontinued in \n___ with DVT in ___ s/p IVC filter placement on ___', 'CVA ___ years ago, several TIAs with no residual deficits', 'HTN', 'HLD', 's/p PPM for bradycardia'], 'family_history': 'Father - passed away from brain aneurysm at age ___\nMother - passed away at age ___, had PE\nBrother - passed away at age ___ from PE\nDaughter - heart condition, was on the heart transplant list at \n___, but now medically managed', 'present_illness': 'Mr. ___ is a ___ gentleman with a history of CAD s/p \nCABG and revision, DVT/PE s/p IVC filter placement on ___, \nCHF with EF 50% on ___, CVA, and stage II CLL with four \nrecent admissions for progressive dyspnea and persistent pleural \neffusion. \n\nAbout ___ years ago, he started noticing dyspnea on exertion. \nPrior to that, he had been able to go shopping and carry \ngrocery. This was attributed to his CHF. Within the last 2 \nmonths, his dyspnea worsened to the point where he could only \nwalk 1 block before he was short of breath. During this time, he \nalso noticed dizziness, lightheadedness and unsteadiness when he \nstood up. Over the past ___ years, he had used 2 pillows when \nsleeping and has been able to sleep well with that recently. He \ndoes not use supplemental oxygen at home.\n\nDuring ___ and ___, the patient presented to ___ \nand ___ for dyspnea and were diagnosed with worsened CHF. \n\nOn ___, he was admitted to the ___ for weakness and dyspnea \nand found to have a pleural effusion and underwent \nthoracentesis. Fluid studies showed an exudative effusion with \n"abundant small lymphocytes, lymphoproliferative disorder cannot \nbe ruled out". \n\nOn ___, he was readmitted for shortness of breath and \nfounding to have an increasing pleural effusion. At this time, a \npigtail catheter was placed, which drained fluid until removal \non ___. The fluid was positive for CLL, felt to be due to \npheripheral blood contamination from hemothorax. At that time, \ncoumadin was held due to concerns about hemothorax in the \nsetting of supratherapeutic INR. \n\nOn ___, he was again readmitted for shortness of breath, \nfound to have stable effusion and atelectasis and given \nincentive spirometry inpatient. \n\nOn ___, he presented for a fourth time with a new complaint \nof right thigh pain and was found to have right proximal ___ DVT, \ns/p IVC filter placement by ___. At that time, a chest tube was \nagain placed, with fluid showing exudate with no bacteria or \nAFB. The chest tube has been outputing >300cc per day for 5 days \nup to transfer. The pleural effusion was felt to be due to \ntrapped lung following consolidation of hemorrhagic pleural \neffusion in the setting of anticoagulation. Thoracic surgery \nfelt that he was not a good candidate for operative \ndecortication due to her comorbidities. The patient has been \ntransferred to ___ for second opinion. \n\nOn the floor, vs were: T 97.8 P 80 BP 109/63 R 20 O2 sat \n100%/2L. He reports feeling comfortable with mild pain on his \nback from the chest tube.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Vitamin D', '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': 'Bethanechol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fludrocortisone Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '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': 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': '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': '135', 'valuenum': 135.0, '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': '31.1', 'valuenum': 31.1, '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': '26.3', 'valuenum': 26.3, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '486', 'valuenum': 486.0, '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': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T 97.8 BP 109/63 HR 80 RR 20 O2sat 100%/2L\nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: Supple, JVP not elevated, negative hepatojugular reflex, \nno LAD \nLungs: Breathing comfortably, lower left lung dull to \npercussion, mild wheezing right anterior and left anterior and \nlateral, coarse rhonchi on left, prominently over the lower \nposterior area, chest tube on lower left posterior-lateral side \nwith serosangrenous fluid drainage\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSkin: Ecchymoses on abdominal from lovenox injections.\nNeuro: Alert, oriented x3, CNII-CNXII intact, ___ strength UE \nand ___ bilaterally, sensation intact throughout.', 'diagnoses': [{'icd_code': '2631', 'desc': 'Malnutrition of mild degree'}, {'icd_code': 'V850'}, {'icd_code': '7994', 'desc': 'Cachexia'}, {'icd_code': '7837', 'desc': 'Adult failure to thrive'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}, {'icd_code': '5303', 'desc': 'Stricture and stenosis of esophagus'}, {'icd_code': 'V1003', 'desc': 'Personal history of malignant neoplasm of esophagus'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'V1301', 'desc': 'Personal history of urinary calculi'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': " WBC RBC Hgb Hct MCV MCH MCHC RDW Plt \nCt \n___ 07:35 37.2* 2.81* 7.8* 25.4* 90 27.9 31.0 15.1 236 \n\n___ 06:00 23.8* 2.58* 7.0* 22.9* 89 27.2 30.6* 15.0 \n195 \n___ 08:20 25.5* 2.63* 7.2* 23.5* 89 27.2 30.4* 15.1 \n183 \n___ 08:10 20.9* 2.51* 6.8* 22.2* 89 27.1 30.6* 15.1 \n167 \n___ 07:35 14.8* 2.35* 6.6* 21.3* 91 28.2 31.2 15.0 \n146* \n___ 09:15 17.8* 2.54* 7.0* 23.5* 92 27.5 29.9* 14.7 \n175 \n___ 12:04 27.2* 2.99* 8.2* 27.7* 93 27.5 29.7* 14.6 \n182 \n___ 16:27 40.3* 3.48* 9.9* 32.1* 92 28.5 30.9* 15.0 \n254 \nSource: Line-aline \n___ 06:15 19.4* 3.16* 8.7* 29.1* 92 27.5 29.9* 14.9 \n182 \nDIFF ADDED ___ @ 10:35 \n___ 06:00 23.1* 3.27* 8.9* 29.8* 91 27.3 30.0* 15.0 \n196 \n___ 06:30 23.4* 3.45* 9.4* 31.5* 91 27.4 30.0* 15.1 \n195 \n___ 05:50 24.6* 3.49* 9.5* 31.8* 91 27.3 30.0* 15.3 \n179 \n___ 06:05 29.4* 3.53* 10.0* 31.9* 90 28.3 31.3 15.3 \n182 \n___ 15:20 35.7* 3.51* 9.9* 31.3* 89 28.3 31.7 15.5 185 \n\n\n Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 07:35 103*1 5* 0.6 137 3.6 ___ \n___ 06:00 101*1 7 0.6 136 4.0 100 32 8 \n___:20 861 10 0.6 138 4.5 ___ \n___ 08:10 104*1 12 0.6 141 3.7 101 32 12 \n___ 08:35 109*1 12 0.6 141 3.8 99 34* 12 \n___ 07:35 114*1 14 0.6 137 4.0 97 33* 11 \n___ 12:04 106*1 14 0.7 136 4.6 98 34* 9 \n___ 16:27 128*1 16 0.7 138 4.7 ___ \nSource: Line-aline \n___ 06:15 101*1 15 0.7 137 4.2 98 35* 8 \n___ 06:00 105*1 16 0.8 136 4.2 99 33* 8 \n___ 06:30 106*1 15 0.9 137 4.7 98 34* 10 \n___ 06:05 841 14 0.8 135 3.9 97 30 12 \n___ 15:20 961 12 0.9 134 4.3 95* 29 14 \n\n \n\nSTUDIES:\n-----------------\n\n___ CHEST (PORTABLE AP) \nFINDINGS: No previous images. Left chest tube is in place and \nthere is \nopacification at the left base consistent with pleural fluid and \natelectatic change. In the appropriate clinical setting, \nsupervening pneumonia would have to be considered. \nNo definite evidence of pneumothorax. \nThere is hyperexpansion of the lungs suggesting chronic \npulmonary disease in this patient with a previous CABG and \ndual-channel pacer. Of incidental note are several old healed \nrib fractures on the right. \n\n___ CHEST (PA & LAT) \nIMPRESSION: \n1. Lungs remain hyperinflated suggestive of underlying \nemphysematous changes. There is an air-fluid level at the left \ncostophrenic sulcus consistent with a small hydropneumothorax. \nThe patient is status post median sternotomy. Overall cardiac \nand mediastinal contours are stable. A dual-lead left-sided \npacer remains in place. Several right-sided old rib fractures \nare again identified. Patchy opacity at the left base likely \nreflects partial lower lobe atelectasis related to the presence \nof the effusion. No evidence of pulmonary edema. Results were \ncommunicated by phone to the patient's nurse, ___ at 9:05 \na.m. given the discrepancy with the wet reading. \n\n___ CHEST (PORTABLE AP) \nIMPRESSION: \n1. Dual-lead left-sided pacer remains in place. The patient is \nstatus post median sternotomy and there are multiple surgical \nclips overlying the cardiac and mediastinal contours as well as \nthe upper abdomen. Left basilar chest tube remains in place and \nthe loculated pneumothorax at the left base may be slightly \nsmaller as a fluid level is no longer appreciated; however, this \ncould just be related to differences in positioning. Multiple \nright-sided rib fractures are again identified. There continues \nto be patchy left basalir opacity likely reflecting atelectasis. \n Small right effusion is now evident. \n\n___ ECG \nSinus rhythm. Normal tracing. No previous tracing available for \ncomparison.\nRate PR QRS QT/QTc P QRS T \n86 0 ___ 0 2 25 \n\n___ ECHO \nThe left atrium and right atrium are normal in cavity size. The \nestimated right atrial pressure is ___ mmHg. Left ventricular \nwall thickness, cavity size, and global systolic function are \nnormal (LVEF>55%). Due to suboptimal technical quality, a focal \nwall motion abnormality cannot be fully excluded. Tissue Doppler \nimaging suggests a normal left ventricular filling pressure \n(PCWP<12mmHg). Right ventricular chamber size and free wall \nmotion are normal. The aortic valve leaflets are mildly \nthickened (?#). There is no aortic valve stenosis. No aortic \nregurgitation is seen. The mitral valve leaflets are \nstructurally normal. There is no mitral valve prolapse. Mild \n(1+) mitral regurgitation is seen. The estimated pulmonary \nartery systolic pressure is normal. There is no pericardial \neffusion. \nIMPRESSION: Suboptimal image quality. Normal biventricular \ncavity sizes with preserved global biventricular systolic \nfunction. Mild mitral regurgitation with normal valve \nmorphology. \n\n___ CHEST (PORTABLE AP) \nFINDINGS: As compared to the previous radiograph, the \nleft-sided chest tube is in unchanged position. A minimal \npleural air accumulation might be present at the site of tube \ninsertion. The lung apex, however, does not show signs of \npneumothorax. The small amount of left pleural fluid appears to \nbe unchanged. Unchanged appearance of the cardiac silhouette and \nof the right lung. Left pectoral pacemaker in situ. \n\n___ Head CT :\nNo intracranial hemorrhage or acute territorial infarction\n\n___ CXR \nInterval removal of left chest tube without appreciable pleural \nfluid or air collection \n\n___ Video swallow ;\nBarium passes freely through the oropharynx and esophagus \nwithout evidence of obstruction. There was aspiration of thin \nliquids. A thickened epiglottis is noted \n\n___ 10:52 am THROAT FOR STREP\n\n **FINAL REPORT ___\n\n R/O Beta Strep Group A (Final ___: \n NO BETA STREPTOCOCCUS GROUP A FOUND.\n___ year old man with Stage II CLL, CAD s/p CABG and stents, \nprior DVTs, and recent persistent recurrent pleural effusion s/p \nmultiple thoracentesis who was transferred to ___ for \ncontinued managment of hemorraghic pleural effusions. This next \nportion of his hospital course reflects his time on the Medical \nService\n\nActive issues:\n\n# Dyspnea: O2 saturation well on 2L and no oxygen requirement at \nhome. Likely due to persistent large output pleural effusion. \nBNP elevated but no evidence of right sided heart failure, with \npure left sided heart failure possible. Differential for \nexudative pleural effusion includes malignancy-related, lung \nentrapment, PE, infectious, and lymphatic abnormalities. CLL has \nbeen stable over the past years. He had a negative CTA for PE on \n___ and IVC filter placed on ___ by ___. He had a workup at \n___ was overall negative. His persistent pleural effusion is \nlikely due to trapped lung, where following inflammation and \nscarring from recent pleural effusions, part of his left lung \nwas adherent to the pleura and unable to expand with the pleura \ncontinuing to produce excessive fluids. Thoracic surgery and \ninterventional pulmonology were consulted, and recommended \npleurx catheter, IP biopsy and catheter, or thoracic \ndecortication surgery. Following family meeting and discussions \nwith the patient, the patient decided to undergo decortication \nsurgery. He had a normal pre-op echocardiogram (EF>55% and no \npulmonary hypertension), ECG, and PFTs. He underwent \ndecortication surgery on ___. \n\nChronic issues:\n\n# DVT: RLE DVT on US at the ___ on ___ off anticoagulation \n(due to hemorrhagic pleural effusion in the setting of \nanticoagulation), s/p IVC filter placement on ___. He was \nplaced on subcutaneous heparin while inpatient at ___. Family \nhistory of PEs suggest possible coagulopathy.\n\n# CHF: EF 50% on ___. No evidence of right sided heart \nfailure on exam. He was continued on home doses of metoprolol \nand simvastatin.\n \n# CAD: s/p CABG and revision. He was continued on home doses of \naspirin, simvastatin, and metoprolol.\n\n# BPH: No evidence of urinary symptoms inpatient. Continued home \ndose of tamsulosin.\n\nTRANSITIONAL ISSUES:\n# CODE: Full (confirmed with patient)\n# CONTACT: HCP, Son, ___. Contact ___ and \n___ (cell) ___ and (home) ___ \n\nThis next portion relates to his Surgical course.\nHe was taken to the Operating Room on ___ and underwent a \nleft thoracotomy with decortication. He tolerated the procedure \nwell and returned to the PACU in stable condition. He \nmaintained stable hemodynamics and his pain was controlled with \nan epidural catheter. \nFollowing transfer to the Surgical floor he had some episodes of \ndesaturation and required vigorous pulmonary toilet and \nincreased nebulizer treatments. His chest tubes were removed \nand his pain was much improved. Following removal of his \nepidural catheter, he was able to void easily. He did have some \nissues with delirium , mainly over night and the geriatric \nservice was consulted for a general assessment. His B12 and TSH \nwere checked and were normal and soon after allowing him more \ntime to rest at night and stopping narcotics, he improved. He \ndid have a head CT which was negative for any acute process. \nHe was seen by the Physical Therapy service and they recommended \na short term rehab prior to returning home so that he could \nimprove his mobility and endurance. He also was seen by the \nspeech and swallow service as he complained of some dysphagia \neven months before this hospitalization. He failed a bedside \nevaluation and then had a video swallow which showed some \naspiration with thin liquids. Currently his diet is pureed \nsolids and nectar thic liquids with meds crushed in applesauce. \nHe will need to be re evaluated at rehab for advancement. Along \nwith his dysphagia, he also complained of a sore throat. His \nstrep culture is negative and his symptoms resolved with \nnystatin therefore ___ esophagitis was included in the \ndifferential. His WBC was 37 on admission and 37 at discharge \ndue to his CLL therefore he was pan cultured on ___. 1 of \n4 bottles had some GPC's, likely a contaminent but will be \nfollowed. his urine culture was negative. His Coumadin was \nbriefly resumed but after talking with his PCP, the decision had \nbeen made to omit further Coumadin in light of his pulmonary \nissues.\nAfter a long hospital stay he was discharged to rehab on \n___ and will follow up in the Thoracic Clinic in 2 weeks."}}
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{'final_diagnoses': ['Fibrothorax', 'Deep vein thrombosis', 'Congestive heart failure', 'Coronary artery disease', 'Benign prostate hypertrophy', '___ esophagitis', 'CLL'], 'procedures': ['Left thoracotomy, decortication'], 'visit_summary': "___ year old man with Stage II CLL, CAD s/p CABG and stents, \nprior DVTs, and recent persistent recurrent pleural effusion s/p \nmultiple thoracentesis who was transferred to ___ for \ncontinued managment of hemorraghic pleural effusions. This next \nportion of his hospital course reflects his time on the Medical \nService\n\nActive issues:\n\n# Dyspnea: O2 saturation well on 2L and no oxygen requirement at \nhome. Likely due to persistent large output pleural effusion. \nBNP elevated but no evidence of right sided heart failure, with \npure left sided heart failure possible. Differential for \nexudative pleural effusion includes malignancy-related, lung \nentrapment, PE, infectious, and lymphatic abnormalities. CLL has \nbeen stable over the past years. He had a negative CTA for PE on \n___ and IVC filter placed on ___ by ___. He had a workup at \n___ was overall negative. His persistent pleural effusion is \nlikely due to trapped lung, where following inflammation and \nscarring from recent pleural effusions, part of his left lung \nwas adherent to the pleura and unable to expand with the pleura \ncontinuing to produce excessive fluids. Thoracic surgery and \ninterventional pulmonology were consulted, and recommended \npleurx catheter, IP biopsy and catheter, or thoracic \ndecortication surgery. Following family meeting and discussions \nwith the patient, the patient decided to undergo decortication \nsurgery. He had a normal pre-op echocardiogram (EF>55% and no \npulmonary hypertension), ECG, and PFTs. He underwent \ndecortication surgery on ___. \n\nChronic issues:\n\n# DVT: RLE DVT on US at the ___ on ___ off anticoagulation \n(due to hemorrhagic pleural effusion in the setting of \nanticoagulation), s/p IVC filter placement on ___. He was \nplaced on subcutaneous heparin while inpatient at ___. Family \nhistory of PEs suggest possible coagulopathy.\n\n# CHF: EF 50% on ___. No evidence of right sided heart \nfailure on exam. He was continued on home doses of metoprolol \nand simvastatin.\n \n# CAD: s/p CABG and revision. He was continued on home doses of \naspirin, simvastatin, and metoprolol.\n\n# BPH: No evidence of urinary symptoms inpatient. Continued home \ndose of tamsulosin.\n\nTRANSITIONAL ISSUES:\n# CODE: Full (confirmed with patient)\n# CONTACT: HCP, Son, ___. Contact ___ and \n___ (cell) ___ and (home) ___ \n\nThis next portion relates to his Surgical course.\nHe was taken to the Operating Room on ___ and underwent a \nleft thoracotomy with decortication. He tolerated the procedure \nwell and returned to the PACU in stable condition. He \nmaintained stable hemodynamics and his pain was controlled with \nan epidural catheter. \nFollowing transfer to the Surgical floor he had some episodes of \ndesaturation and required vigorous pulmonary toilet and \nincreased nebulizer treatments. His chest tubes were removed \nand his pain was much improved. Following removal of his \nepidural catheter, he was able to void easily. He did have some \nissues with delirium , mainly over night and the geriatric \nservice was consulted for a general assessment. His B12 and TSH \nwere checked and were normal and soon after allowing him more \ntime to rest at night and stopping narcotics, he improved. He \ndid have a head CT which was negative for any acute process. \nHe was seen by the Physical Therapy service and they recommended \na short term rehab prior to returning home so that he could \nimprove his mobility and endurance. He also was seen by the \nspeech and swallow service as he complained of some dysphagia \neven months before this hospitalization. He failed a bedside \nevaluation and then had a video swallow which showed some \naspiration with thin liquids. Currently his diet is pureed \nsolids and nectar thic liquids with meds crushed in applesauce. \nHe will need to be re evaluated at rehab for advancement. Along \nwith his dysphagia, he also complained of a sore throat. His \nstrep culture is negative and his symptoms resolved with \nnystatin therefore ___ esophagitis was included in the \ndifferential. His WBC was 37 on admission and 37 at discharge \ndue to his CLL therefore he was pan cultured on ___. 1 of \n4 bottles had some GPC's, likely a contaminent but will be \nfollowed. his urine culture was negative. His Coumadin was \nbriefly resumed but after talking with his PCP, the decision had \nbeen made to omit further Coumadin in light of his pulmonary \nissues.\nAfter a long hospital stay he was discharged to rehab on \n___ and will follow up in the Thoracic Clinic in 2 weeks.", 'medications_prescribed': ['Simvastatin 10 mg PO DAILY', 'Metoprolol Tartrate 50 mg PO BID', 'Albuterol 0.083% Neb Soln 1 NEB IH Q4H', 'Artificial Tears ___ DROP BOTH EYES PRN dry eye', 'Bisacodyl 10 mg PO/PR DAILY:PRN constipation', 'Docusate Sodium 100 mg PO BID', 'guaiFENesin 100 mg/5 mL oral QID', 'Heparin 5000 UNIT SC BID', 'Lansoprazole Oral Disintegrating Tab 30 mg PO BID', 'Nystatin Oral Suspension 10 mL PO QID \ngive thru ___', 'Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush', 'Tamsulosin 0.4 mg PO HS', 'Maalox/Diphenhydramine/Lidocaine 15 mL PO QID:PRN throat \npain', 'Aspirin 81 mg PO DAILY', 'carboxymethylcellulose sodium 0.5 % ophthalmic TID', 'ipratropium bromide 0.03 % nasal TID', 'Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY', 'Nitroglycerin SL 0.4 mg SL PRN chest pain', 'Vitamin D 1000 UNIT PO DAILY', 'Acetaminophen (Liquid) 1000 mg PO TID']}
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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': 'abdominal pain', 'medical_history': ['CAD, no PCI', 'HTN', 'HLD', 'Ulcerative colitis s/p colectomy with ileostomy', 'GERD', 'Pseudogout', 'CCY'], 'family_history': 'Brother with liver disease. Denies gallbladder or pancreas \ndisease in family.', 'present_illness': '___ with CAD, HTN, HLD, GERD who presents with 1 day history of \nabdominal pain.\n.\nHe was in his usual state of health until last ___. At that time \nhe was eating dinner and developed epigastric abdominal pain, \nwhich was ___. He was brought to the ED for this. He also had \nnausea. He denies fevers, chills, vomiting, constipation, \ncoughing, dysuria, or other symptoms.\n.\nUpon presentation to the ED, initial vitals were: pain 7, T \n97.7, HR 75, BP 164/69, RR 16, SvO2 98% RA. He was found to have \ntransaminitis. RUQ ultrasound showed a distended bile duct with \nconcern for obstruction and recommended ERCP vs MRCP. He \ndeveloped a fever to 101.4 and was started on unasyn. He was \ngiven morphine for pain control. He received 1L NS. He was \nadmitted to the floor.\n.\n LFTs were significant for AST of 319, ALT of 690, AP of 983, \nand TBili of 2.4. WBC 11.6. Patient was started on unasyn and \nthen sent up to 12R. ERCP consulted and decision was made to go \nfor procedure.\n.\nIn ERCP suite, patient was electively intubated due to food in \nstomach. Spiked to 101.8 pre-procedure and blood cxs were drawn. \nBecame hypotensive during the procedure requiring peripheral \nneo. ERCP showed lots of pus from ampulla, stones and a stent \nwas placed. In the PACU, A-line was placed and neo was switched \nto levophed, he received 4L LR, and was on propofol for \nsedation. \n.\nOn arrival to the MICU, patient remained intubated and on \nlevophed with SBPs in the ___ on the A-line. There was some \nconcern that the PIV infiltrated with levophed so phentolamine \nwas ordered.', 'medications': [{'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', '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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Insulin', 'proc_type': 'IV Piggyback', '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued 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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS: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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': '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', '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}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.27', 'valuenum': 1.27, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.9', 'valuenum': 1.9, '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '125', 'valuenum': 125.0, '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': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '353', 'valuenum': 353.0, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '170', 'valuenum': 170.0, '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': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '262', 'valuenum': 262.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.3', 'valuenum': 5.3, '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': '-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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.33', 'valuenum': 1.33, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '161', 'valuenum': 161.0, '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': 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': '3.4', 'valuenum': 3.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 69.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 7.19, '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': '128', 'valuenum': 128.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, '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': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, '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': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '33.7', 'valuenum': 33.7, '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': '173', 'valuenum': 173.0, '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': '3.81', 'valuenum': 3.81, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 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': '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', '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': '1.25', 'valuenum': 1.25, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '281', 'valuenum': 281.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': '-6', 'valuenum': -6.0, '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': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.24, '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': '95', 'valuenum': 95.0, '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': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': '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': '97', 'valuenum': 97.0, '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': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.22', 'valuenum': 1.22, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.25', 'valuenum': 1.25, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-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': '1.24', 'valuenum': 1.24, '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': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', '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': '4.8', '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, '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': '3.71', 'valuenum': 3.71, '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': '9', 'valuenum': 9.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, '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': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, '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': '3.47', 'valuenum': 3.47, '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': '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': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.1', '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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.86', 'valuenum': 2.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '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': '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': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Exam:\nGeneral: no apparent distress, sleeping\nPain: ___\nVitals: T 98.9, BP 96/47, HR 84, RR 16, SvO2 95% RA\nHEENT: dry MM\nNeck: low JVD\nCardiac: rr, nl rate, no murmurs\nLungs: CTAB\nAbd: soft, nontender, nondistended, positive bowel sounds, no \nr/r/g, ostomy\nExt: wwp, no edema\nNeuro: grossly intact\nPsych: pleasant\n.\nDischarge exam:\nGen: NAD\nPain: ___\nVitals: 98.3, 140s/80s, 60-70s, 18, 99%RA\nabd: soft, NTND, normal bowel sounds, ostomy site intact without \nsurrounding TTP, erythema\nExt: WWP, no edema\nNeuro: A&Ox3', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '43310', 'desc': 'Occlusion and stenosis of carotid artery without mention of cerebral infarction'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': '___ 02:35AM BLOOD WBC-11.6*# RBC-4.88 Hgb-15.9 Hct-42.9 \nMCV-88 MCH-32.7* MCHC-37.1* RDW-13.0 Plt ___\n___ 02:35AM BLOOD Neuts-89.6* Lymphs-6.3* Monos-2.0 Eos-1.7 \nBaso-0.4\n___ 07:51AM BLOOD ___ PTT-25.2 ___\n___ 02:35AM BLOOD Glucose-99 UreaN-25* Creat-1.0 Na-136 \nK-6.9* Cl-100 HCO3-25 AnGap-18\n___ 02:35AM BLOOD ALT-319* AST-690* AlkPhos-98 TotBili-2.4*\n___ 02:35AM BLOOD Lipase-48\n___ 02:35AM BLOOD Albumin-4.8\n___ 04:15AM BLOOD K-4.2\n___ 08:04AM BLOOD Lactate-2.7*\n___ 03:35AM URINE Color-Straw Appear-Clear Sp ___\n___ 03:35AM URINE Blood-SM Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n___ 03:35AM URINE RBC-2 WBC-2 Bacteri-NONE Yeast-NONE Epi-0\n.\nRUQ U/S: IMPRESSION: Moderate intrahepatic biliary duct \ndilatation, dilatation of the common bile duct to 1.___s dilatation of the main pancreatic duct to 4 mm. While the \npancreatic duct was previously prominent, it appears possibly \nincreased comparatively. Patient with prior history of \ncholecystectomy. This constellation of findings suggests \nobstruction at the level of the ampulla. Differential includes \npancreatic head mass, obstructing stone or ampullary stricture. \nRecommend MRCP or ERCP for further characterization. \n.\nCXR: No acute cardiopulmonary abnormality. No evidence of \npneumoperitoneum.\n.\nLabs prior to discharge:\n___ 06:05AM BLOOD WBC-13.0*\n___ 06:05AM BLOOD ___ PTT-28.9 ___\n___ 06:20AM BLOOD Glucose-96 UreaN-17 Creat-0.7 Na-140 \nK-3.5 Cl-104 HCO3-25 AnGap-15\n.\nBlood culture results:\n___ 2:38 am BLOOD CULTURE Source: Line-TLC re port. \n\n Blood Culture, Routine (Preliminary): \n KLEBSIELLA PNEUMONIAE. \n IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # \n___\n FROM ___. \n\n___ 7:45 am BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: \n STREPTOCOCCUS BOVIS GROUP. STREPTOCOCCUS INFANTARIUS. \n IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # \n___\n ___. \n KLEBSIELLA PNEUMONIAE. \n IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # \n___\n ___. \n ENTEROCOCCUS CASSELIFLAVUS. FINAL SENSITIVITIES. \n\n___ 9:13 pm CATHETER TIP-IV Source: R IJ. \n\n **FINAL REPORT ___\n\n WOUND CULTURE (Final ___: No significant growth.\n\n___ and ___ blood cultures pending.\n___ 06:05AM BLOOD ALT-116* AST-52* AlkPhos-108 TotBili-2.3*\n___ with history of CCY who presents with concern for \ncholangitis.\n\n#cholangitis/Septic shock: The patient presented with elevated \nLFTs, abdominal pain and fevers subsequently found to have \npolymicrobial bacteremia and frank pus in the biliary system \nduring ERCP. During ERCP, patient was intubated for airway \nprotection and developed shock requiring pressors during the \nprocedure. After the procedure, he was transferred to the \nmedical ICU for management. Antibiotics were broadened to \nVancomycin, Cefepime, and Flagyl. His lactate peaked at 3.4 and \nbegan downtrending with fluid resuscitation. He was extubated \nthe day following admission, and his antibiotics were narrowed \nto Vancomycin and Ciprofloxacin. Ultimately he was found to have \nenterococcus, klebsiella, and strep bovus from blood cultures, \nand klebsiella grew from his ___ blood culture drawn from his \ncentral line. The line was discontinued, and antibiotic changed \nto unasyn (___) to finish a ten day treatment course for \ntreatment of his bacteremia as well as central line associated \nbacterial infection. A PICC line was placed ___, which can \nbe discontinued after the antibiotic course is finished.\n.\n#Left peripheral IV infiltration: During ERCP, the patient was \nstarted on peripheral levo in PACU with development of left \nperipheral IV site infiltration. On exam, this appeared minor, \nand he was administered phentolamine with improvement of exam. \n.\n#Coronary Artery Disease: The patient has a history of positive \nstress tests but no previous catheterizations. Some of his chest \npain in the past was felt to be atypical in nature. Cardiac \nbiomarkers were trended and rose slightly to peak Trop-T 0.03. \nHis home beta-blocker was initially held in the setting of \nshock, and restarted prior to discharge.\n.\n# Pseudogout: His allopurinol was held during this admission and \nstopped on discharge, to be restarted at the discretion of his \nPCP. He did not have any flares of pseudogout during the \nhospitalization.'}}
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{'final_diagnoses': ['cholangitis', 'sepsis', 'bacteremia', 'central line associated bacterial infection'], 'procedures': ['ERCP'], 'visit_summary': '___ with history of CCY who presents with concern for \ncholangitis.\n\n#cholangitis/Septic shock: The patient presented with elevated \nLFTs, abdominal pain and fevers subsequently found to have \npolymicrobial bacteremia and frank pus in the biliary system \nduring ERCP. During ERCP, patient was intubated for airway \nprotection and developed shock requiring pressors during the \nprocedure. After the procedure, he was transferred to the \nmedical ICU for management. Antibiotics were broadened to \nVancomycin, Cefepime, and Flagyl. His lactate peaked at 3.4 and \nbegan downtrending with fluid resuscitation. He was extubated \nthe day following admission, and his antibiotics were narrowed \nto Vancomycin and Ciprofloxacin. Ultimately he was found to have \nenterococcus, klebsiella, and strep bovus from blood cultures, \nand klebsiella grew from his ___ blood culture drawn from his \ncentral line. The line was discontinued, and antibiotic changed \nto unasyn (___) to finish a ten day treatment course for \ntreatment of his bacteremia as well as central line associated \nbacterial infection. A PICC line was placed ___, which can \nbe discontinued after the antibiotic course is finished.\n.\n#Left peripheral IV infiltration: During ERCP, the patient was \nstarted on peripheral levo in PACU with development of left \nperipheral IV site infiltration. On exam, this appeared minor, \nand he was administered phentolamine with improvement of exam. \n.\n#Coronary Artery Disease: The patient has a history of positive \nstress tests but no previous catheterizations. Some of his chest \npain in the past was felt to be atypical in nature. Cardiac \nbiomarkers were trended and rose slightly to peak Trop-T 0.03. \nHis home beta-blocker was initially held in the setting of \nshock, and restarted prior to discharge.\n.\n# Pseudogout: His allopurinol was held during this admission and \nstopped on discharge, to be restarted at the discretion of his \nPCP. He did not have any flares of pseudogout during the \nhospitalization.', 'medications_prescribed': ['Pantoprazole 40 mg PO Q24H', 'Ampicillin-Sulbactam 3 g IV Q6H \nYou should receive this through ___ then stop.', 'Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush', 'Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush', 'Ascorbic Acid ___ mg PO DAILY', 'Aspirin 81 mg PO DAILY', 'calcium citrate 250 mg calcium Oral BID', 'Diphenoxylate-Atropine 1 TAB PO BID:PRN diarrhea', 'Ferrous Sulfate 325 mg PO DAILY', 'lutein 20 mg Oral daily', 'Metoprolol Succinate XL 100 mg PO DAILY', 'Multivitamins 1 TAB PO DAILY', 'Potassium Chloride 20 mEq PO DAILY', 'Vitamin D ___ UNIT PO BID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 58, 'gender': 'F', 'symptoms': 'Dizziness, orthostasis', 'medical_history': ['-Lactose intolerance', '-inguinal hernia repair as a child.', '-Thyroiditis on biopsy', '-Gallstones asymptomatic', '-Colon Cancer resected ___ Status post six cycles (11 doses) of\nFOLFOX completed on ___. Colonoscopy in ___ found\na single adenoma. This was removed and recommended repeat\ncolonoscopy in ___.', '-Blood tests in ___ showed a hemoglobin A-1 C of\n6.2,', '- ___ total cholesterol 257, LDL 163, HDL 63, triglycerides \n153,\nthis was discussed with the patient over the telephone and she\nwanted to try to lose weight which she has done to have it\nrepeated rather than start medication. ___ LDL ___ colonoscopy small adenoma next ___.', '-Holter monitor ___ no significant arrhythmias.', '-Neuropathy secondary chemotherapy.', '-___: stress test and she had no anginal symptoms went over 9\nminutes but there were EKG changes at 9 minutes. I recommended\natorvastatin 20 mg of aspirin 81 mg.', '-Patient has refused all vaccines.'], 'family_history': 'The patient states that her sister was diagnosed with colon \ncancer in her ___. She states that her sister underwent surgery \nand radiation and is alive and well today at the age of ___. She \nsays that her father had prostate cancer\ndiagnosed in his ___, as well as a brother who is diagnosed with\nprostate cancer in his ___. Mother had angina and died from\naneurysm ? where.', 'present_illness': "___ pmh of stage IIIC colon cancer and hypertension p/w \nlightheadedness, referred from ___'s office when found to be \northostatic. Patient was seen in the emergency department ___ \nwith weakness, nausea, palpitations and URI symptoms. She was \ndischarged home with supportive care. She felt slightly better \nsince then, but still weak then awoke this morning with profound \nweakness and lightheadedness when standing up. She went to see \nher primary care doctor who noted that she had orthostatic \nhypotension. 126/95 and HR 86 supine to 96/64 and HR 104 \nstanding. EKG in PCP's office showed normal sinus rhythm at 92, \nincomplete right\nbundle branch block otherwise normal. PCP was concerned that she \nwas orthostatic but did not looks dehydrated, and referred her \nto the ED for expedited workup including ECHO to look for acute \ncardiomyopathy leading to decreased EF, neurological evaluation \nto look for treatable causes of autonomic failure as well as \npossibly a trial of midodrine.\n\nIn the ED initial vitals 12:08 0 97.4 88 116/77 16 98% RA. \nOrthostatics (not sure if this was after receiving 2L NS or not) \nwere \nToday 17:40 laying 98.4 80 168/95 16 100% RA \nToday 17:50 sitting 75 180/96 16 99% RA \nToday 17:51 standing 82 141/89 16 100% RA \n\nIn the ED she denied any chest pain, shortness of breath, \nabdominal pain, myalgias, fever, sore throat, dysuria. Labs \nshowed WBC 7.9 (from 2.6 on ___ with 78%N, 15%L, 1%E, Hgb 15.3 \n(from 13.5 on ___, Plt 213 (from 121 on ___, K 5.2 (from \n3.8). CXR no acute process. \n\nAdmission Vitals: Today 20:13 0 98.1 67 153/88 16 97% RA \n\nOn arrival to the floor she reports that her symptoms have \nresolved completely after receiving IVF in the ED. She also \nreports that over the last few days (since having cold symptoms \na week ago) she has not had much of an appetite and did not have \nmuch to eat/drink yesterday. This AM she felt weak and \nlightheaded after standing up in the AM.", 'medications': [{'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'GlipiZIDE', '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': 'Vitamin B Complex', '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': 'Fish Oil (Omega 3)', '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/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ID', 'frequency': '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': 'Multivitamins', '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': 'MedroxyPROGESTERone Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'GlipiZIDE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'GlipiZIDE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ID', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Tacrolimus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'GlipiZIDE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tuberculin Protein', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ID', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Negative.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.043', 'valuenum': 0.043, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '230', 'valuenum': 230.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, 'flag': 'abnormal', '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': '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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '___'}, {'value': '340', 'valuenum': 340.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, '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', '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': '48', 'valuenum': 48.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '4.5', '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': '201', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '147', 'valuenum': 147.0, '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': '2.55', 'valuenum': 2.55, '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': '40.6', 'valuenum': 40.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.8, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Target 12-HR Trough (early Post-TX): 5-20 (24 hr Trough 33-50%Lower) . Measured by ___..'}, {'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': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'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': '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '62', 'valuenum': 62.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.5', 'valuenum': 25.5, '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': '28.6', 'valuenum': 28.6, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, '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': 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': '40.6', 'valuenum': 40.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '101', 'valuenum': 101.0, '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': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.6, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Target 12-HR Trough (early Post-TX): 5-20 (24 hr Trough 33-50%Lower) . Measured by ___..'}, {'value': '25.7', 'valuenum': 25.7, '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': '28.5', 'valuenum': 28.5, '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': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, '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': 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': '41.1', 'valuenum': 41.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "Admission Exam:\n===============\nVS: supine 154/95 HR 71, sitting 162/97 HR 73, standing (taken \nimmediately) 145/78 asymptomatic HR 70's, standing after 3 \nminutes 149/92 and still asymptomatic\nGeneral: WD/WN, NAD, sons at bedside\n___: MMM, EOMI, upper dentures\nNeck: supple\nCV: RRR, no m/r/g, lays flat easily \nLungs: ctab\nAbdomen: nt/nd +bs\nExt: no c/c/e\nSkin: no rashes\n\nDischarge Exam:\n===============\nVS: Tc 98.2, BP 156/95, HR 62, RR 18, 99% RA\nGeneral: WD/WN, NAD, sons at bedside\n___: MMM, EOMI, upper dentures\nNeck: supple\nCV: RRR, no m/r/g, lays flat easily \nLungs: ctab\nAbdomen: nt/nd +bs\nExt: no c/c/e\nSkin: no rashes", 'diagnoses': [{'icd_code': 'T8612', 'desc': 'Kidney transplant failure'}, {'icd_code': 'N186', 'desc': 'End stage renal disease'}, {'icd_code': 'Z7682', 'desc': 'Awaiting organ transplant status'}, {'icd_code': 'Z944', 'desc': 'Liver transplant status'}, {'icd_code': 'Y830', 'desc': 'Surgical operation with transplant of whole organ 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': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z96643', 'desc': 'Presence of artificial hip joint, bilateral'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R918', 'desc': 'Other nonspecific abnormal finding of lung field'}, {'icd_code': 'D631', 'desc': 'Anemia in chronic kidney disease'}, {'icd_code': 'E11649', 'desc': 'Type 2 diabetes mellitus with hypoglycemia without coma'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}], 'summary': "LABS ON ADMISSION/DISCHARGE:\n===========================\n\n___ 07:03AM BLOOD WBC-7.9 RBC-4.96 Hgb-13.7 Hct-40.1 \nMCV-81* MCH-27.5 MCHC-34.0 RDW-14.4 Plt ___\n___ 02:43PM BLOOD Glucose-129* UreaN-17 Creat-0.8 Na-138 \nK-5.2* Cl-102 HCO3-26 AnGap-15\n___ 07:03AM BLOOD Glucose-139* UreaN-15 Creat-0.6 Na-140 \nK-4.1 Cl-107 HCO3-26 AnGap-11\n\nCXR ___:\nIMPRESSION: \nNo acute intrathoracic process. \n\nEKG:\nnormal sinus rhythm\nMs. ___ is a ___ with a history of Stage IIIC colon cancer \ns/p FOLFOX in ___ with resultant neuropathy but no evidence of \nrecurrent disease, as well as a history of thyroiditis, stress \ntest ___ with ischemic EKG changes but no symptoms, who \npresents with recent likely viral illness and now generalized \nweakness and lightheadedness found to be orthostatic that \nresolved after IVF. \n\n#Orthostatic hypotension. \nPatient presented with weakness and lightheadedness in setting \nof recent viral illness (that had resolved) supported by recent \nlabs ___ notable for leukopenia and thrombocytopenia which \nresolved at time of admission. This prodromal viral illness and \nfeeling unwell per patient's report lead to decreased PO intake \nand volume depletion before the onset of her weakness and \nlightheadedness. The patient was noted to be orthostatic in the \nED, admitted to the medicine floor, and was given IVF with \nresolution of her orthostatic symptoms prior to discharge. EKG \nalso showed normal sinus rhythm. She was also able to ambulate \nwithout issue prior to discharge. She was encouraged to maintain \nPO intake upon discharge.\n\n#Possible CAD. \n-continued home ASA, statin"}}
|
{'final_diagnoses': ['Orthostatic hypotension', 'Colon cancer'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is a ___ with a history of Stage IIIC colon cancer \ns/p FOLFOX in ___ with resultant neuropathy but no evidence of \nrecurrent disease, as well as a history of thyroiditis, stress \ntest ___ with ischemic EKG changes but no symptoms, who \npresents with recent likely viral illness and now generalized \nweakness and lightheadedness found to be orthostatic that \nresolved after IVF. \n\n#Orthostatic hypotension. \nPatient presented with weakness and lightheadedness in setting \nof recent viral illness (that had resolved) supported by recent \nlabs ___ notable for leukopenia and thrombocytopenia which \nresolved at time of admission. This prodromal viral illness and \nfeeling unwell per patient's report lead to decreased PO intake \nand volume depletion before the onset of her weakness and \nlightheadedness. The patient was noted to be orthostatic in the \nED, admitted to the medicine floor, and was given IVF with \nresolution of her orthostatic symptoms prior to discharge. EKG \nalso showed normal sinus rhythm. She was also able to ambulate \nwithout issue prior to discharge. She was encouraged to maintain \nPO intake upon discharge.\n\n#Possible CAD. \n-continued home ASA, statin", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Calcium Carbonate 500 mg PO BID', 'Fish Oil (Omega 3) 1000 mg PO DAILY', 'Vitamin B Complex 1 CAP 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': 61, 'gender': 'F', 'symptoms': 'worsening pain', 'medical_history': ['OB Hx: \nSAB x 2 -> D&C x 2\nEmergent C/S at 31wks for NRFHT after IOL for PEC/PRES', 'GYN Hx: denies hx of STI. LEEP x 1.', 'Allergy: Lamictal -> rash', 'PMH: Asthma, Labile BPs, postural tachycardia, migraines ,PFO,\nIBS, Depression with SI, anxiety, abd pain of unclear etiology\n(CT scan ___ notable only for hiatal hernia)', 'PSH: C/S'], 'family_history': None, 'present_illness': '___ G4P0121 at 7w2d GA by LMP ___ with known ectopic\npregnancy, s/p methotrexate on ___ presents from clinic with\nworsened abdominal pain, located in LLQ pain that radiates to\ngroin and back. Pain previously coming and going, but now always\npresent with episodes of sharp pain. Unrelieved by 2 tablets of\ndilaudid (4mg) this morning. Car ride over from ultrasound was\nextremely painful. Worsened nausea today, no vomiting. No\nfever/chills. Patient had TVUS today that showed no free fluid.\nBright red vaginal bleeding yesterday, spotting; this morning\n+dark brown spotting. No dizziness.\n\nROS: +loose stools yesterday', 'medications': [{'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', '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': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Cholestyramine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', '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': 'CefePIME', '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': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H: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': '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': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID: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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'NORepinephrine', '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': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', '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', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Digoxin', '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': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', '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': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5%', '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': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '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': 'Ciprofloxacin 0.3% Ophth Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EARS', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'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': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID: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': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '318', 'valuenum': 318.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.58', 'valuenum': 0.58, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '3+.'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'SPUN HCT.'}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '41.1', 'valuenum': 41.1, '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': '122', 'valuenum': 122.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72.5', 'valuenum': 72.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '239', 'valuenum': 239.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL. VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': '2.02', 'valuenum': 2.02, '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': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.67', 'valuenum': 0.67, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, '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': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': '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': '___', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HCT.'}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125.0', 'valuenum': 125.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '1.99', 'valuenum': 1.99, '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': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': '>20.'}, {'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': '62', 'valuenum': 62.0, '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': '1.8', '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1486', 'valuenum': 1486.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '12', 'valuenum': 12.0, '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': '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': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.032', 'valuenum': 1.032, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, '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': 0.4, 'ref_range_upper': 1.1, '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': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, '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': '54', 'valuenum': 54.0, '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 174.0, 'valueuom': 'mg/dL', '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': '4.2', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HEMATOCRIT PERFORMED.'}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, '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': '124', 'valuenum': 124.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '1.54', 'valuenum': 1.54, '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': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HEMATOCRIT PERFORMED.'}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '74.3', 'valuenum': 74.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, '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': 61.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '6', 'valuenum': 6.0, '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': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HEMATOCRIT PERFORMED.'}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, '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': '___', 'valuenum': 113.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LABEL VERIFIED.'}, {'value': '291', 'valuenum': 291.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '2.03', 'valuenum': 2.03, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 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'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '___', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HCT.'}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '1+.'}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, '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': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 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'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, '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': '34.7', 'valuenum': 34.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '232', 'valuenum': 232.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.51', 'valuenum': 2.51, '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': '86.3', 'valuenum': 86.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '16.6', 'valuenum': 16.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, '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': '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 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Hemolysis falsely elevates this test.'}, {'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': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72.8', 'valuenum': 72.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.26', 'valuenum': 2.26, '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': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.73', 'valuenum': 0.73, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.3', 'valuenum': 87.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.1', 'valuenum': 50.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '29', 'valuenum': 29.0, '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': '1.2', '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': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '420', 'valuenum': 420.0, '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': '22.5', 'valuenum': 22.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '46', 'valuenum': 46.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.26', 'valuenum': 2.26, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86.6', 'valuenum': 86.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', '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 = 35 if non African-American (mL/min/1.73 m2). Estimated GFR = 43 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '158', 'valuenum': 158.0, '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': '17.7', 'valuenum': 17.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.5', 'valuenum': 44.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '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': '141', 'valuenum': 141.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '71', 'valuenum': 71.0, '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': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, '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': "Using this patient's age, gender, and serum creatinine value of 1.5, . Estimated GFR = 35 if non African-American (mL/min/1.73 m2) . Estimated GFR = 43 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '1684', 'valuenum': 1684.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 203.0, 'valueuom': 'mg/dL', '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': '<10*.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '24.7', 'valuenum': 24.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.21', 'valuenum': 2.21, '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': '87.6', 'valuenum': 87.6, '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': '28', 'valuenum': 28.0, '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': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '36.1', 'valuenum': 36.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/14.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 152.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '150', 'valuenum': 150.0, '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': '53', 'valuenum': 53.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, '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': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.11', 'valuenum': 2.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.5', 'valuenum': 87.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1570', 'valuenum': 1570.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, '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': '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': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': '<10*.'}, {'value': '6', 'valuenum': 6.0, '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': '2.9', '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': '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': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 37.2, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': 'AX = 97.'}, {'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': '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': '34', 'valuenum': 34.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': 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'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, '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': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.17', 'valuenum': 2.17, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90.0', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, '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': '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': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 170.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 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{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60.0', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.98', 'valuenum': 1.98, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.0', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, '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': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS:\nT 98.1, HR 76, BP 133/82, RR 24\nPhysical exam:\nNAD, lying down with knees flexed\nAbd: soft, mildly distended, +rebound, tender on left to light\npalpation\nPelvic: deferred', 'diagnoses': [{'icd_code': 'R6520', 'desc': 'Severe sepsis without septic shock'}, {'icd_code': 'G92', 'desc': 'Toxic encephalopathy'}, {'icd_code': 'D65', 'desc': 'Disseminated intravascular coagulation [defibrination syndrome]'}, {'icd_code': 'G08', 'desc': 'Intracranial and intraspinal phlebitis and thrombophlebitis'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'R4020', 'desc': 'Unspecified coma'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'D589', 'desc': 'Hereditary hemolytic anemia, unspecified'}, {'icd_code': 'I69354', 'desc': 'Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side'}, {'icd_code': 'I82C11', 'desc': 'Acute embolism and thrombosis of right internal jugular vein'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'E870', 'desc': 'Hyperosmolality and hypernatremia'}, {'icd_code': 'D61818', 'desc': 'Other pancytopenia'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'H409', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'H7091', 'desc': 'Unspecified mastoiditis, right ear'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'R571', 'desc': 'Hypovolemic shock'}], 'summary': '___ 12:22PM BLOOD WBC-5.2 RBC-3.76* Hgb-10.7* Hct-31.6*\nMCV-84 MCH-28.5 MCHC-33.9 RDW-15.0 Plt ___\n___ 12:22PM BLOOD Neuts-71.8* ___ Monos-3.5 Eos-1.6\nBaso-0.3\nOn ___, Ms. ___ was admitted to the gynecology service \nwith worsening abdominal pain in the setting of a known ectopic \npregnancy. An ultrasound prior to admission did not show \nevidence of rupture. She was admitted for pain control and \nobservation. She remained hemodynamically stable with continued, \nbut stable abdominal pain, and she made the decision on hospital \nday #1, about 3 hours after admission, that she wanted to \nundergo surgical management of the ectopic pregnancy. She was \nthus taken to the operating room for a laparoscopic left \nsalpingectomy and lysis of adhesions. See operative report for \ndetails.\n\nHer post-operative course was uncomplicated. Immediately \npost-op, her pain was controlled with IV dilaudid and toradol. \nOn post-operative day 1, her urine output was adequate so her \nfoley was removed and she voided spontaneously. Her diet was \nadvanced without difficulty and she was transitioned to oral \npain medication.\n\nBy post-operative day 1, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled.'}}
|
{'final_diagnoses': ['Left ectopic pregnancy, non-ruptured'], 'procedures': ['Left ectopic s/p laparoscopic left salpingectomy, lysis of adhesions'], 'visit_summary': 'On ___, Ms. ___ was admitted to the gynecology service \nwith worsening abdominal pain in the setting of a known ectopic \npregnancy. An ultrasound prior to admission did not show \nevidence of rupture. She was admitted for pain control and \nobservation. She remained hemodynamically stable with continued, \nbut stable abdominal pain, and she made the decision on hospital \nday #1, about 3 hours after admission, that she wanted to \nundergo surgical management of the ectopic pregnancy. She was \nthus taken to the operating room for a laparoscopic left \nsalpingectomy and lysis of adhesions. See operative report for \ndetails.\n\nHer post-operative course was uncomplicated. Immediately \npost-op, her pain was controlled with IV dilaudid and toradol. \nOn post-operative day 1, her urine output was adequate so her \nfoley was removed and she voided spontaneously. Her diet was \nadvanced without difficulty and she was transitioned to oral \npain medication.\n\nBy post-operative day 1, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled.', 'medications_prescribed': ['1. Fluoxetine 20 mg PO DAILY', '2. Ibuprofen 600 mg PO Q6H:PRN pain \nRX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours \nDisp #*30 Tablet Refills:*1', '3. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain \nRX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth \nevery four (4) hours Disp #*20 Tablet Refills:*0', '4. Pantoprazole 40 mg PO Q24H', '5. Propranolol 60 mg PO DAILY', '6. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp \n#*30 Tablet Refills:*1']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'Duodenal polyp', 'medical_history': ['Prior back surgery', 'Hyperlipidemia', 'GERD', 'Hiatal hernia'], 'family_history': 'Father died in ___ of ALS. Mother died ___ of cardiac disease.\nBrother had polyps removed at young age.', 'present_illness': 'The patient is a ___ gentleman with a history of \nhyperlipidemia, who has had duodenal polyps removed in the third \nand fourth portion of the duodenum and also has one closer up in \nthe second portion of the duodenum. He had a bleed after the \nremoval of one and went home and ultimately got better after \nhaving a significant bleed. He was recently re-endoscoped and\nthe area of the resection in the third and fourth portion of the \nduodenum is growing back adenomatous tissue and this is no \nlonger manageable endoscopically. The patient was evaluated by \nDr. ___ possible surgical resection. All risks, benefits \nand possible outcomes were discussed with the patient, he was \nscheduled for elective operation on ___.', 'medications': [{'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': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', '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': 'Sodium Chloride 0.9% Flush', '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', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, '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': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, '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': '357', 'valuenum': 357.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, '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': 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': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, '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': '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': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '357', 'valuenum': 357.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Prior discharge:\nVS: 98.1, 71, 136/73, 18, 95 % RA\nGEN: NAD, AAO x 3\nCV: RRR, no m/r/g\nPULM: CTAB\nABD: Right subcostal incision open to air with staples. \nEXTR: Warm, no c/c/e', 'diagnoses': [{'icd_code': '1983', 'desc': 'Secondary malignant neoplasm of brain and spinal cord'}, {'icd_code': '1749', 'desc': 'Malignant neoplasm of breast (female), unspecified'}, {'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': "___ 10:30AM BLOOD WBC-9.1 RBC-4.29* Hgb-12.9* Hct-40.0 \nMCV-93 MCH-30.2 MCHC-32.3 RDW-13.1 Plt ___\n___ 07:30AM BLOOD Glucose-103* UreaN-8 Creat-0.7 Na-141 \nK-3.3 Cl-104 HCO___ AnG___\nThe patient with history of duodenal adenoma was admitted to the \nHPB Surgical Service for elective partial duodenectomy. On \n___, the patient underwent D3/D4 regional duodenectomy with \nprimary duodenojejunostomy anastomosis and open cholecystectomy \nwith common bile duct exploration, which went well without \ncomplication (reader referred to the Operative Note for \ndetails). After a brief, uneventful stay in the PACU, the \npatient arrived on the floor NPO with NGT, on IV fluids, with a \nfoley catheter, and epidural catheter for pain control. The \npatient was hemodynamically stable.\nNeuro: The patient received Hydromorphone/Bupivacaine via \nepidural catheter with good effect and adequate pain control. \nWhen tolerating oral intake, the patient was transitioned to \noral pain medications.\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirrometry were \nencouraged throughout hospitalization.\nGI/GU/FEN: Post-operatively, the patient was made NPO/NGT with \nIV fluids. On POD # 4 patient underwent upper GI study, which \nwas negative for leak. Diet was advanced to clears ans was well \ntolerated. Diet was progressively advanced to regular on POD # \n5. Patient's intake and output were closely monitored, and IV \nfluid was adjusted when necessary. Electrolytes were routinely \nfollowed, and repleted when necessary.\nID: No issues\nEndocrine: No issues\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required.\nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay; was encouraged to get \nup and ambulate as early as possible.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan."}}
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{'final_diagnoses': ['Chronic cholecystitis', 'Cholelithiasis'], 'procedures': ['D3/D4 regional duodenectomy.', 'Primary duodenojejunostomy anastomosis.', 'Open cholecystectomy with common bile duct exploration.'], 'visit_summary': "The patient with history of duodenal adenoma was admitted to the \nHPB Surgical Service for elective partial duodenectomy. On \n___, the patient underwent D3/D4 regional duodenectomy with \nprimary duodenojejunostomy anastomosis and open cholecystectomy \nwith common bile duct exploration, which went well without \ncomplication (reader referred to the Operative Note for \ndetails). After a brief, uneventful stay in the PACU, the \npatient arrived on the floor NPO with NGT, on IV fluids, with a \nfoley catheter, and epidural catheter for pain control. The \npatient was hemodynamically stable.\nNeuro: The patient received Hydromorphone/Bupivacaine via \nepidural catheter with good effect and adequate pain control. \nWhen tolerating oral intake, the patient was transitioned to \noral pain medications.\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirrometry were \nencouraged throughout hospitalization.\nGI/GU/FEN: Post-operatively, the patient was made NPO/NGT with \nIV fluids. On POD # 4 patient underwent upper GI study, which \nwas negative for leak. Diet was advanced to clears ans was well \ntolerated. Diet was progressively advanced to regular on POD # \n5. Patient's intake and output were closely monitored, and IV \nfluid was adjusted when necessary. Electrolytes were routinely \nfollowed, and repleted when necessary.\nID: No issues\nEndocrine: No issues\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required.\nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay; was encouraged to get \nup and ambulate as early as possible.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan.", 'medications_prescribed': ['Acetaminophen 325-650 mg PO Q6H:PRN pain/fever', 'Aspirin 81 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'Omeprazole 20 mg PO BID', 'Senna 8.6 mg PO BID', 'Simvastatin 20 mg PO DAILY', 'OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*80 Tablet Refills:*0', 'TraMADOL (Ultram) 50 mg PO Q6H:PRN pain \nRX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp \n#*50 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': '"right flank pain and fevers"', 'medical_history': ['Past Oncologic History: \n1. Acute Myelogenous Leukemia: He was initially diagnosed in \n___ with FAB-M6 AML at which time he received induction \nchemotherapy with 7+3 followed by high-dose ARA-C for 4 cycles. \nIn ___, he relapsed and received MEC followed by one \ncycle of clofarabine and ARA-C. He had a subsequent admission \nfor febrile neutropenia requiring admission for about three \nweeks and was discharged on IV daptomycin and oral \nciprofloxacin, which he continued the course. He was admitted on \n___ for double cord blood transplant for AML. His \nconditioning regimen consisted of fludarabine, ATG and \nmelphalan. His post-transplant course was complicated by \ncoag-negative staph, which was methicillin resistant and was \nfound to have thrombophlebitis of the brachiocephalic and left \nIJ vein with inflammation extending into the adjacent \nmediastinum. He also had headaches prompting lumbar puncture. He \nhad a positive CMV viral load and was started on ganciclovir. He \nhas \nbeen found to have evidence of BK virus in his urine but has \nremained asymptomatic. He was admitted from ___ with \nCMV retinitis in the setting of a negative viral load. Last bone \nmarrow biospy was in ___.', "Other Past Medical History: \nITP (with admission in ___ for thrombocytopenia)\nCrohn's Disease - Previously treated with high dose steroids and \ns/p ileal resection for Crohn's disease. \nHerpes Zoster/Post-Herpetic Neuralgia \nMitral Valve Prolapse \nEBV positive \nStatus post appendectomy \nStatus post cholecystectomy. \nNephrolithiasis \nH/o pansensitive Klebsiella bacteremia ___ \nS/p ORIF of left tibia after motorcycle accident"], 'family_history': 'Mother died of cancer (age ___, father died of cerebral \naneurysm. No other family history of cancer. Has one brother, in \ngood health. Children are well.', 'present_illness': "Mr. ___ is a ___ y/o male with a h/o AML s/p double cord blood \nSCT in ___, recent ITP, h/o nephrolithiasis, h/o Crohn's \ndisease, and recent admission for hypotension and bronchitis who \npresents from the ED with fevers and right flank pain.\n.\nSymptom of right flank pain started ___ around 8 pm, pt went to \nbed, but felt very poor and checked temp at 4am on ___, this \nwas 100.5, he went back to bed and woke up at 7:30am in \nexcruciating pain and was taken to the emergency department in \n___ where he had a cxray and abd plain films and was then \nreferred to ___ after he developed a fever of 101.7 He did \nnot receive any antibiotics. On arrival to ___ he had a temp \nof 100.4, HR 99 and the right flank pain had resolved. He did \nnot feel well, but nothing in particular. Tmax in our ED of \n101.0 Cxray was performed followed by noncontrast CT of the \nabd/pelvis, followed by RLE ultrasound (leg was slightly more \nswollen than left) and ultimatly b.c of fidings on cxray he had \na CT/PE done which showed a clot in the right lung field. He \nwas started on heparin and arrived to the floor around 1am on \n___. When I see him he notes that he is tired, but feeling \nbetter. He denies any current chest pain, flank pain, fever, \nchills, n/v, abd pain, urgency, frequency, dysuria.\n.\nHe was recently seen in the ED on ___ and diagnosed with \nzoster. He was sent home on oral acyclovir. At his last \nadmission (discharged ___, he was found to be hypotensive in \nclinic to 73/56. He was given IVF and CT chest showed a subtle, \ndiffuse process throughout his lungs and viral respiratory \nscreen came back positive for RSV. Pulmonology felt that his \nclinical picture was consistent with a bronchitis. He improved \nwith IV fluids.", 'medications': [{'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', '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': '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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (EXTended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '35.5', 'valuenum': 35.5, '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': '29.6', 'valuenum': 29.6, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.93', 'valuenum': 3.93, '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': '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.9', '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.016', 'valuenum': 1.016, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Physical Exam: White male in NAD lying in bed, good mood, very \npleasant VSS currently afebrile\nHEENT: mostly bald, left eye with ___ vision and slight blur \nthan right, oropharynx nml, nasal nml, no lad\nCV:rrr\nPULM: lungs ctab\nABD:soft nt, multiple scars\nLIMBS: left lower leg with multiple scars, healed skin tears. \nRLE has some varicosities\nNEURO: grossly nml', 'diagnoses': [{'icd_code': '85241', 'desc': 'Extradural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': '920', 'desc': 'Contusion of face, scalp, and neck except eye(s)'}, {'icd_code': '9210', 'desc': 'Black eye, not otherwise specified'}, {'icd_code': 'E8843', 'desc': 'Accidental fall from wheelchair'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': '29590', 'desc': 'Unspecified schizophrenia, unspecified'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}], 'summary': "COMPLETE BLOOD COUNT WBC Hgb Hct MCV Plt Ct \n___ 06:00AM 6.8 9.4 27.9 100 264 \n___ 07:00AM 7.1 10.0 29.8 99 231 \n___ 05:45PM 9.8 10.6 31.3 96 258 \n.\n DIFFERENTIAL Neuts Lymphs Monos Eos Baso\n___ 07:00AM 81.1* 14.3* 4.2 0.3 0.1 \n___ 05:45PM 71.3* 22.4 5.9 0.2 0.3\n. \n BASIC COAGULATION ___ PTT INR\n___ 06:00AM 15.1 37.4 1.3 \n___ 07:00AM 16.4 95.0 1.5 \n___ 11:30PM 16.3 30.6 1.4 \n.\n___ 01:10PM Thrombn 13.0\n___ 01:10PM Lupus PND ACA IgG PND ACA IgM PND \n.\n RENAL & GLUCOSE Gluc BUN Cr Na K Cl HCO3 AnGap \n___ 06:00AM ___ 140 4.1 ___ \n___ 07:00AM 113 13 0.9 136 3.6 98 \n___ 05:45PM ___ 137 4.2 96 31 14 \n.\n ENZYMES & BILIRUBIN ALT AST LD(LDH) AlkPhos TotBili \n___ 07:00AM 24 24 191 96 0.5 \n___ 05:45PM 30 30 213 104 0.5 \n___ 05:45PM Lipase 21 \n.\n CHEMISTRY Albumin Ca Phos Mg Uric Acid\n___ 06:00AM 8.3 3.2 2.0 \n___ 07:00AM 3.2 3.0 1.5 5.3 \n.\n___ 05:44PM Lactate 1.1 \n.\nURINALYSIS NEG \n.\n___ CMV Viral Load-PENDING \n___ URINE CULTURE-NO GROWTH\n___ BLOOD CULTURE-PENDING \n___ BLOOD CULTURE-PENDING\n.\n.\nCXR ___: IMPRESSION: Bibasilar atelectasis, right worse than \nleft. Small right pleural effusion. Question possible \nsubpulmonic component given now marked discrepancy in the \nheights of the apparent hemidiaphragms. \n.\nCT Abd/Pelvis ___: IMPRESSION: \n1. No evidence of right renal nephro- or uretero-lithiasis. \n2. 13-mm left renal collecting system staghorn calculus without \nhydronephrosis. \n3. T8 wedge deformity, age indeterminate, but likely chronic. \n.\nRLE Dopplers ___: IMPRESSION: No evidence of DVT in the \nright lower extremity.\n.\nCTA Chest ___: IMPRESSION: \n1. Segmental pulmonary embolus in vessels supplying the \nposterior basal \nsegment of the right lower lobe, with small pulmonary infarct \nand trace right pleural effusion. Findings are equivocal for \nright heart strain. Given the overall lack of clot burden, \ncorrelation with echocardiography may be useful. \n2. No acute abnormalities in the abdomen or pelvis.\nPt is a ___ yo male with history of AML s/p double cord blood SCT \nin ___, ITP, herpes zoster/post-herpetic neurolgia, Crohn's \ndisease, CMV retinitis, now admitted for right flank pain and \nfevers, found to have a pulmonary embolism.\n.\n# Fevers: Pt had temp of 101 in the ED, subsequently was \nafebrile on the floor. It was likely due to infart caused by PE. \n Pt remained afebrile and studies did not indicate any infection \n(UA, CXR, cultures). A CMV viral load was still pending at time \nof discharge.\n.\n# PE: Pt was initiated on Heparin gtt. The following day, pt \nwas switched to Lovenox (1mg/kg q12h). Coumadin was also \nstarted (5mg on the first day and 2.5mg daily on subsequent \ndays). Coumadin was dosed with caution as pt is also on \nFluconazole. Pt's INR was 1.3 on day of discharge. Pt was \ndischarged with Lovenox and Coumadin. Pt was also given an \noutpt order for an INR check on ___, with results to \nbe faxed to ___ at ___. Pt was instructed \nthat further dosing of Coumadin and future INR checks will be \ndirected by ___. Given history of ITP, \nanti-cardiolipin abs and lupus anticoagulant studies were \nordered and were pending at time of discharge. \n.\n# ITP: Pt's plts remained in normal levels. Pt was continued on \nPrednisone 5 mg daily.\n.\n# AML: Pt is s/p double cord blood SCT in ___. Recent BM \nbiopsy showed no evidence of leukemia. Pt was continued on \nAcyclovir and Fluconazole for prophylaxis. Pt was instructed to \nmake a follow-up appointment with ___ this \nweek. \n.\n# Herpes zoster/post-herpetic neurolgia: Pt received his last \ndose of 10d course of Acyclovir 800mg 5x/day, then switched to \nprophylactic dose. Pt was also continued on home Gabapentin and \nAmitriptyline. Pt was discharged on Oxycontin 10mg BID for \nbasal control and Oxycodone 5mg as needed for breakthrough pain.\n.\n# HTN: Well-controlled. Pt was continued on home Metoprolol.\n.\n# R>L lower extremity edema: Pt was noted to have R>L leg \nswelling. LENIs showed no DVT. There was no erythema or warmth \nto touch to indicate cellulitis. Pt was instructed to seek \nmedical attention if redness, swelling or fevers develop."}}
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{'final_diagnoses': ['Pulmonary Embolism', 'AML s/p cord SCT ___', 'ITP', 'Herpes Zoster', "Crohn's", 'HTN'], 'procedures': ['None'], 'visit_summary': "Pt is a ___ yo male with history of AML s/p double cord blood SCT \nin ___, ITP, herpes zoster/post-herpetic neurolgia, Crohn's \ndisease, CMV retinitis, now admitted for right flank pain and \nfevers, found to have a pulmonary embolism.\n.\n# Fevers: Pt had temp of 101 in the ED, subsequently was \nafebrile on the floor. It was likely due to infart caused by PE. \n Pt remained afebrile and studies did not indicate any infection \n(UA, CXR, cultures). A CMV viral load was still pending at time \nof discharge.\n.\n# PE: Pt was initiated on Heparin gtt. The following day, pt \nwas switched to Lovenox (1mg/kg q12h). Coumadin was also \nstarted (5mg on the first day and 2.5mg daily on subsequent \ndays). Coumadin was dosed with caution as pt is also on \nFluconazole. Pt's INR was 1.3 on day of discharge. Pt was \ndischarged with Lovenox and Coumadin. Pt was also given an \noutpt order for an INR check on ___, with results to \nbe faxed to ___ at ___. Pt was instructed \nthat further dosing of Coumadin and future INR checks will be \ndirected by ___. Given history of ITP, \nanti-cardiolipin abs and lupus anticoagulant studies were \nordered and were pending at time of discharge. \n.\n# ITP: Pt's plts remained in normal levels. Pt was continued on \nPrednisone 5 mg daily.\n.\n# AML: Pt is s/p double cord blood SCT in ___. Recent BM \nbiopsy showed no evidence of leukemia. Pt was continued on \nAcyclovir and Fluconazole for prophylaxis. Pt was instructed to \nmake a follow-up appointment with ___ this \nweek. \n.\n# Herpes zoster/post-herpetic neurolgia: Pt received his last \ndose of 10d course of Acyclovir 800mg 5x/day, then switched to \nprophylactic dose. Pt was also continued on home Gabapentin and \nAmitriptyline. Pt was discharged on Oxycontin 10mg BID for \nbasal control and Oxycodone 5mg as needed for breakthrough pain.\n.\n# HTN: Well-controlled. Pt was continued on home Metoprolol.\n.\n# R>L lower extremity edema: Pt was noted to have R>L leg \nswelling. LENIs showed no DVT. There was no erythema or warmth \nto touch to indicate cellulitis. Pt was instructed to seek \nmedical attention if redness, swelling or fevers develop.", 'medications_prescribed': ['1. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*15 Tablet(s)* Refills:*0*', '2. Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime) as needed for sleep. ', '3. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '4. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for anxiety. ', '5. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO Q8H (every \n8 hours). ', '6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '7. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day). ', '9. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours). ', '10. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous \nQ12H (every 12 hours).\nDisp:*14 * Refills:*0*', '11. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*15 Tablet(s)* Refills:*0*', '12. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours). ', '13. OxyContin 10 mg Tablet Sustained Release 12 hr Sig: One (1) \nTablet Sustained Release 12 hr PO twice a day.\nDisp:*14 Tablet Sustained Release 12 hr(s)* Refills:*0*', '14. Outpatient Lab Work\nCheck ___, PTT, INR on ___ and fax results to ___ \n___ at ___. Her phone number is ___.']}
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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': 'Hyperkalemia, ___ on CKD', 'medical_history': ['- Obesity', '- DM 2', '- Obstructive sleep apnea', '- Status post corneal transplant ___', '- Obesity', '- High cholesterol', '- CAD - h/o MI', '- Gout', '- Chronic kidney disease', '- Dermatitis', '- HTN'], 'family_history': 'Mother passed away from renal failure, family history of CAD, \npancreatic cancer, atherosclerosis', 'present_illness': '___ male with history of DM2, HTN, CAD s/p MI, obesity \nwho presents with hyperkalemia after visit with outpatient \nnephrologist, Dr. ___. Denies any acute changes in health. \nHad routine labs drawn today after an office visit with Dr. \n___. They showed hyperkalemia (K+ 6.2) and acute kidney \ninjury (2.4 from baseline 1.7). He was advised to present to the \nED. ON the way into the ED, patient drank several bottles of \nwater.\n. \nHe takes intermittent ibuprofen and naproxen for joint pain. He \ntook this as recently as yesterday and does it up to a couple of \ntimes per week. Has taken a total of 8 Aleve and 4 Excedrin over \nthe past 2 weeks for joint pains, possibly related to gout. He \ndenies significant change in diet, nausea, vomiting, diarrhea (1 \nloose bowel movement a few days ago), constipation, dehydration. \nNo change in diet. Only new medication is uloric (around 3 \nmonths ago). No recent IV contrast, antibiotics. Denies \ndizziness, lightheadedness, confusion, metalic taste, changes in \nurination, recent infection, decreased appetite. Does not drink \na lot at baseline. Has chronic cramping, possibly worsened in \nthe last couple weeks. Takes quinine regularly.\n. \nIn the ED, initial vitals were: T 97.8, HR 57, BP 134/70, RR 18, \nSvO2 100% RA. EKG without peaked T waves. He was given \nkayexalate and insulin/D50. He was admitted to medicine for \nfurther evaluation and management.\n. \nThis morning he feels well and is without complaints. Cr has \nreturned to close to baseline at 1.9. K+ 4.5.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bumetanide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pramipexole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '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': 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 = 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 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, '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': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, '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': '206', 'valuenum': 206.0, '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': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '46.4', 'valuenum': 46.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Exam:\nVS: Temp 98.2 F, BP 170/106, HR 72, R 18, O2-sat 98% RA \nGENERAL: Well appearing male, no apparent distress \nHEENT: One eyelid not opening, chronic per patient, PERRLA, \nsclerae anicteric, MMM, OP clear \nNECK: Obese, unable to assess JVD \nHEART: RR, nl rate, no r/g/m \nLUNGS: CTAB, no r/rh/wh, good air movement, no accessory muscle \nuse \nABDOMEN: NABS, soft/NT/ND \nEXTREMITIES: WWP, 1+ edema, 2+ peripheral pulses \nSKIN: diffuse rash involving face, chest and upper extremities \nNEURO: awake, A&Ox3, appropriate \n\nDischarge Exam:\nVS: Tm 98.2, Tc97.7 F, BP 134-170/80-106, HR 57-72, R 18, O2-sat \n98% RA, 99% on BIPAP\nGENERAL: Well appearing obese male, no apparent distress \nHEENT: Left eyelid not opening (chronic), PERRLA, sclerae \nanicteric, MMM, OP clear \nNECK: Obese, unable to assess JVD \nHEART: distant RR, nl rate, no r/g/m \nLUNGS: CTAB, no r/rh/wh, good air movement on bipap, no \naccessory muscle use \nABDOMEN: NABS, soft/NT/ND \nEXTREMITIES: WWP, 1+ edema, 2+ peripheral pulses \nSKIN: diffuse dry rash involving face, chest and upper \nextremities (not new)\nNEURO: awake, A&Ox3, appropriate ', 'diagnoses': [{'icd_code': 'I70491', 'desc': 'Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg'}, {'icd_code': 'I70201', 'desc': 'Unspecified atherosclerosis of native arteries of extremities, right leg'}, {'icd_code': 'I509', 'desc': 'Heart failure, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'H409', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'D469', 'desc': 'Myelodysplastic syndrome, unspecified'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z85118', 'desc': 'Personal history of other malignant neoplasm of bronchus and lung'}], 'summary': '___ 02:48PM BLOOD UreaN-32* Creat-2.4* Na-141 K-6.2* Cl-103 \nHCO3-30 AnGap-14\n___ 02:48PM BLOOD Calcium-9.1 Phos-4.1 Mg-1.8\n\nAdmission Labs:\n___ 06:25PM BLOOD WBC-8.3 RBC-3.73* Hgb-11.3* Hct-31.2* \nMCV-84 MCH-30.3 MCHC-36.3* RDW-13.8 Plt ___\n___ 06:25PM BLOOD Neuts-72.6* Lymphs-17.1* Monos-5.5 \nEos-4.4* Baso-0.4\n___ 06:25PM BLOOD ___ PTT-34.6 ___\n___ 06:25PM BLOOD Glucose-105* UreaN-35* Creat-2.2* Na-141 \nK-5.5* Cl-104 HCO3-29 AnGap-14\n___ 06:29PM BLOOD K-5.6*\n\nAdmission UA:\n___ 06:25PM URINE Color-Straw Appear-Clear Sp ___\n___ 06:25PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n___ 04:41AM URINE Eos-POSITIVE \n___ 04:41AM URINE Hours-RANDOM UreaN-947 Creat-146 Na-105 \nK-39 Cl-80\n___ 04:41AM URINE Osmolal-656\n\nDischarge Labs:\n___ 06:40AM BLOOD Glucose-107* UreaN-32* Creat-1.9* Na-139 \nK-4.5 Cl-102 HCO3-26 AnGap-16\n___ 06:40AM BLOOD Mg-1.7\n\nImaging: None\n___ male with history of DM2, HTN, CAD s/p MI, obesity \nwho presents with hyperkalemia and acute on chronic kidney \ninjury, resolved with fluids. \n.\n# Hyperkalemia: 6.2 on admission. Downtrended with D50/insulin \nand kayexalate. EKG was not concerning. Patient was monitored on \ntelemetry overnight. The morning of discharge, K+ was 4.5. This \nwas likely due to acute on chronic kidney injury, and has \nresolved with fluids and improved creatinine.\n.\n# Acute on chronic kidney injury: Likely related to frequent \nNSAID use (especially given rare eosinophilia in urine) and \nfurther exacerbated by ACEI useage. Patient drank several \nbottles of water prior to presentation to the ED and was given \ngentle IVF overnight. No history of decreased PO intake or \nhypovolemic sypmtoms to indicate prerenal or recent anitbiotic \nor IV contrast. Renal was consulted and agreed. They felt he was \na bit overloaded and so he was discharged with lasix 20mg PO \nBID. ACEI was stopped and patient was spoken to at length about \nnot using any form of NSAIDs. He was requested to manage pain \nwith tylenol. \n.\n# DM2: Held metformin and byetta on the inpatient side. Kept on \ninsulin sliding scale with finger sticks of 102 and 131 (had \nbeen given insulin in the ED for kyperkalemia). Resumed home \nbyetta and metformin on discharge. Patient and PCP were made \naware that patient will likely need alternative diabetic regimen \ngiven CKD and Cr of 1.7 at baseline.\n.\n# HTN: Held ACEI. Blood pressure within normal limits over \nadmission.\n.\n# Rash: Continued desonide and triamcinolone as an outpatient. \nPatient states rash is at baseline. \n.\n# OSA: Bipap continued overnight. \n.\n# Gout: Uloric was held on admission, continued on discharge.\n.'}}
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{'final_diagnoses': ['Primary Diagnosis: Acute Kidney Injury and Hyperkalemia', 'Secondary Diagnosis: - Obesity', '- DM 2', '- Obstructive sleep apnea', '- Status post corneal transplant ___', '- Obesity', '- High cholesterol', '- CAD - h/o MI', '- Gout', '- Chronic kidney disease', '- Dermatitis', '- HTN'], 'procedures': ['None'], 'visit_summary': '___ male with history of DM2, HTN, CAD s/p MI, obesity \nwho presents with hyperkalemia and acute on chronic kidney \ninjury, resolved with fluids. \n.\n# Hyperkalemia: 6.2 on admission. Downtrended with D50/insulin \nand kayexalate. EKG was not concerning. Patient was monitored on \ntelemetry overnight. The morning of discharge, K+ was 4.5. This \nwas likely due to acute on chronic kidney injury, and has \nresolved with fluids and improved creatinine.\n.\n# Acute on chronic kidney injury: Likely related to frequent \nNSAID use (especially given rare eosinophilia in urine) and \nfurther exacerbated by ACEI useage. Patient drank several \nbottles of water prior to presentation to the ED and was given \ngentle IVF overnight. No history of decreased PO intake or \nhypovolemic sypmtoms to indicate prerenal or recent anitbiotic \nor IV contrast. Renal was consulted and agreed. They felt he was \na bit overloaded and so he was discharged with lasix 20mg PO \nBID. ACEI was stopped and patient was spoken to at length about \nnot using any form of NSAIDs. He was requested to manage pain \nwith tylenol. \n.\n# DM2: Held metformin and byetta on the inpatient side. Kept on \ninsulin sliding scale with finger sticks of 102 and 131 (had \nbeen given insulin in the ED for kyperkalemia). Resumed home \nbyetta and metformin on discharge. Patient and PCP were made \naware that patient will likely need alternative diabetic regimen \ngiven CKD and Cr of 1.7 at baseline.\n.\n# HTN: Held ACEI. Blood pressure within normal limits over \nadmission.\n.\n# Rash: Continued desonide and triamcinolone as an outpatient. \nPatient states rash is at baseline. \n.\n# OSA: Bipap continued overnight. \n.\n# Gout: Uloric was held on admission, continued on discharge.\n.', 'medications_prescribed': ['1. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '2. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).', '3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '4. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '5. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.', '6. desonide 0.05 % Lotion Sig: One (1) application Topical twice \na day for 2 weeks.', '7. Byetta 10 mcg/0.04 mL Pen Injector Sig: One (1) injection \nSubcutaneous twice a day: before meals, as previously \nprescribed.', '8. triamcinolone acetonide 0.1 % Ointment Sig: One (1) \napplication Topical twice a day: to arms.', '9. Uloric 40 mg Tablet Sig: One (1) Tablet PO once a day.', '10. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.\nDisp:*60 Tablet(s)* Refills:*0*', '11. Outpatient Lab Work\n___ Please check outpatient BMP (Creatinine, electrolytes \nincludine Na+, K+, Ca++, Mg, Phos) and fax results to Dr. \n___ at fax ___.']}
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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': 'Blood draining from G/J Tube', 'medical_history': ['Cerebral palsy/congenital partial L hemiparesis', 'Legal blindness', 'Seizure d/o', 'Hx SDH ___ MVC', 'HTN (EF 55% in ___', 'HLD', 'Hx RLE DVT (___)', 'Hx PE', 'Hx pericardial effusion', 'Hx aspiration PNA', 'OSA', 'Esophageal stricture s/p multiple dilations, and stent placement \n(last ___, Hx UGIB req admission/intubation/13 week hospital \nstay (___)', 'GERD', '___ esophagus', 'ESRD ___ collapsing glomerulonephropathy on HD initiated ___ \n(MWF via RUE AV fistula)', 'BPH', 'Hx C. diff', 'Hx J-tube site infxn managed w/meropenem', 'Depression', 'PSH: craniotomy, evacuation SDH (___), Cervical discectomy, IVC \nfilter, Cholecystectomy, GJ tube placement, R brachial \nart/brachial v Gore-tex AV fistula (___), Replacement AV graft \nRUE (___), esophageal stent insertion (___)'], 'family_history': 'Mother - ASHD w renal art stenosis, renal cell CA. \nFather - ASHD, ___ dementia', 'present_illness': '___ y/o male w/ PMHx esophageal stricture status post stenting \nwhich migrated to stomach, with history of multiple GI bleeds \nwho p/w coffee ground emesis and melena after dialysis today. \nPatient was complaining of generalized abdominal tenderness, \nmild nausea, and was seen to have coffee ground emesis. Went to \nOSH (___), then transferred here for further GI \nevaluation. He was previously scheduled for outpatient endoscopy \ntomorrow with Dr. ___. Labs at OSH showed Hct of 39. Also \nhad temp to 100.5, got ceftriaxone 1 gm and azithro 500mg via \nPEG for possible pneumonia.', 'medications': [{'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': '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': 'PHENObarbital - ICU Alcohol Withdrawal (Initial Load / Rescue Dose)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'PHENObarbital - ICU Alcohol Withdrawal (Initial Load / Rescue Dose)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENObarbital Alcohol Withdrawal Dose Taper (Days 2-7)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENObarbital Alcohol Withdrawal Dose Taper (Days 2-7)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H: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 Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': '1X', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'PHENObarbital Alcohol Withdrawal Dose Taper (Days 2-7)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENObarbital Alcohol Withdrawal Dose Taper (Days 2-7)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 24.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', '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': '208', 'valuenum': 208.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 236.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely decreases this test.'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': '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': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', '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': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '225', 'valuenum': 225.0, '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test. New reference range as of ___.'}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, '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': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.19', 'valuenum': 4.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.5', 'valuenum': 43.5, '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': '8.3', 'valuenum': 8.3, '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': 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': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '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}], 'exams': 'Admission Physical Exam (Medical team):\nVS - Temp 96.5 F, BP 135/78, HR 78, R 18, O2-sat 95% RA \nGENERAL - patient comfortable, in NAD \nHEENT - NC/AT, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \nNEURO - awake, alert, oriented to self (says full name is \n___, and oriented to "hospital", does not know BI, does not \nknow month or president, EOMI \n \nDischarge Physical Exam (Surgical Team)\nVS (morning of d/c): Tm = 98.7, Tc=96.8, HR 70-90, BP \n100-140/60-70, RR 20, SO2 98% RA\nGEN: NAD, sleeping in bed, arousable\nHEENT: NCAT, anicteric slerae\nNECK - supple, no thyromegaly \nLUNGS - Fine rales bilaterally but generally clear, good air \nmovement, resp unlabored \nHEART - RRR, ___ systolic murmur heard best at RUSB \nABDOMEN - Hypoactive BS, soft/NT/ND, no masses or HSM, no \nrebound/guarding, Midline incision is open and healing well with \nwound VAC and clear dressing in place\nBACK - No CVA tenderness, no pressure ulcers on back or bottom\nEXTREMITIES - WWP, very weak peripheral pulses, no pressure \nulcers \nNEURO - awake, alert, oriented to self (says full name is ___ \n___, and oriented to "hospital", does not know BI, does not \nknow month or president, ___ ', 'diagnoses': [{'icd_code': 'S0232XA', 'desc': 'Fracture of orbital floor, left side, initial encounter for closed fracture'}, {'icd_code': 'F209', 'desc': 'Schizophrenia, unspecified'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'Y048XXA', 'desc': 'Assault by other bodily force, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}], 'summary': "Admission Labs (Admitted to medical floor):\n \n___ 11:15PM WBC-8.1 RBC-3.60* HGB-11.7* HCT-34.5* MCV-96 \nMCH-32.6* MCHC-34.0 RDW-14.2\n___ 11:15PM PLT COUNT-153\n___ 05:26PM WBC-6.7 RBC-3.08* HGB-10.2* HCT-30.3* MCV-98 \nMCH-33.1* MCHC-33.6 RDW-13.7\n___ 05:26PM PLT COUNT-141*\n___ 11:40AM WBC-6.9 RBC-2.96* HGB-9.6* HCT-29.6* MCV-100* \nMCH-32.6* MCHC-32.6 RDW-13.6\n___ 11:40AM PLT COUNT-171\n___ 06:54AM GLUCOSE-96 UREA N-32* CREAT-2.9* SODIUM-135 \nPOTASSIUM-3.8 CHLORIDE-94* TOTAL CO2-35* ANION GAP-10\n___ 06:54AM CALCIUM-8.4 PHOSPHATE-3.1 MAGNESIUM-2.8*\n___ 06:54AM WBC-7.4 RBC-3.29* HGB-10.6* HCT-32.6* MCV-99* \nMCH-32.3* MCHC-32.6 RDW-13.4\n___ 06:54AM PLT COUNT-181\n___ 06:54AM ___ PTT-24.9 ___\n___ 05:15AM ___ PTT-25.8 ___\n___ 03:43AM TYPE-MIX PO2-70* PCO2-54* PH-7.41 TOTAL \nCO2-35* BASE XS-7\n___ 03:43AM LACTATE-0.8\n___ 03:43AM HGB-11.4* calcHCT-34 O2 SAT-92\n___ 01:24AM ___ PTT-22.5 ___\n___ 01:20AM GLUCOSE-100 UREA N-29* CREAT-2.8*# SODIUM-134 \nPOTASSIUM-4.1 CHLORIDE-93* TOTAL CO2-31 ANION GAP-14\n___ 01:20AM estGFR-Using this\n___ 01:20AM ALT(SGPT)-17 AST(SGOT)-19 ALK PHOS-133* TOT \nBILI-0.2\n___ 01:20AM CALCIUM-8.7 PHOSPHATE-2.9# MAGNESIUM-2.8*\n___ 01:20AM WBC-9.1 RBC-3.50* HGB-11.9* HCT-34.1* MCV-97 \nMCH-34.1* MCHC-35.0 RDW-13.6\n___ 01:20AM NEUTS-86.2* LYMPHS-6.3* MONOS-6.3 EOS-0.9 \nBASOS-0.4\n___ 01:20AM PLT COUNT-180\n \nCBC Trend:\n___ 01:20AM BLOOD WBC-9.1 RBC-3.50* Hgb-11.9* Hct-34.1* \nMCV-97 MCH-34.1* MCHC-35.0 RDW-13.6 Plt ___\n___ 06:54AM BLOOD WBC-7.4 RBC-3.29* Hgb-10.6* Hct-32.6* \nMCV-99* MCH-32.3* MCHC-32.6 RDW-13.4 Plt ___\n___ 11:40AM BLOOD WBC-6.9 RBC-2.96* Hgb-9.6* Hct-29.6* \nMCV-100* MCH-32.6* MCHC-32.6 RDW-13.6 Plt ___\n___ 05:26PM BLOOD WBC-6.7 RBC-3.08* Hgb-10.2* Hct-30.3* \nMCV-98 MCH-33.1* MCHC-33.6 RDW-13.7 Plt ___\n___ 11:15PM BLOOD WBC-8.1 RBC-3.60* Hgb-11.7* Hct-34.5* \nMCV-96 MCH-32.6* MCHC-34.0 RDW-14.2 Plt ___\n___ 05:40AM BLOOD WBC-7.0 RBC-3.56* Hgb-11.3* Hct-35.0* \nMCV-98 MCH-31.9 MCHC-32.4 RDW-13.8 Plt ___\n___ 12:52PM BLOOD WBC-6.7 RBC-3.60* Hgb-11.6* Hct-35.1* \nMCV-97 MCH-32.2* MCHC-33.1 RDW-13.7 Plt ___\n___ 05:48PM BLOOD WBC-7.1 RBC-3.70* Hgb-11.9* Hct-36.3* \nMCV-98 MCH-32.1* MCHC-32.8 RDW-13.6 Plt ___\n___ 10:05PM BLOOD WBC-6.6 RBC-3.69* Hgb-12.4* Hct-37.2* \nMCV-101* MCH-33.6* MCHC-33.4 RDW-13.8 Plt ___\n___ 05:50PM BLOOD WBC-5.2 RBC-3.50* Hgb-11.8* Hct-35.0* \nMCV-100* MCH-33.8* MCHC-33.8 RDW-13.6 Plt ___\n___ 06:25AM BLOOD WBC-8.6# RBC-3.60* Hgb-11.9* Hct-35.6* \nMCV-99* MCH-33.0* MCHC-33.4 RDW-13.4 Plt ___\n___ 06:42PM BLOOD Hct-39.2*\n___ 02:32PM BLOOD Hct-36.4*\n___ 07:06AM BLOOD WBC-6.5 RBC-3.16* Hgb-11.0* Hct-32.2* \nMCV-102* MCH-34.7* MCHC-34.0 RDW-13.2 Plt ___\n___ 06:33AM BLOOD Hct-31.3*\n___ 06:51AM BLOOD WBC-8.6 RBC-3.39* Hgb-11.3* Hct-33.8* \nMCV-100* MCH-33.4* MCHC-33.5 RDW-12.8 Plt ___\n___ 06:30AM BLOOD WBC-10.3 RBC-3.32* Hgb-11.0* Hct-33.5* \nMCV-101* MCH-33.1* MCHC-32.8 RDW-12.9 Plt ___\n___ 07:49AM BLOOD WBC-8.6 RBC-3.28* Hgb-10.8* Hct-32.5* \nMCV-99* MCH-32.8* MCHC-33.1 RDW-12.8 Plt ___\n___ 06:05AM BLOOD WBC-9.4 RBC-3.03* Hgb-9.9* Hct-30.7* \nMCV-101* MCH-32.6* MCHC-32.2 RDW-13.3 Plt ___\n___ 04:52AM BLOOD WBC-9.2 RBC-3.02* Hgb-9.8* Hct-30.4* \nMCV-101* MCH-32.4* MCHC-32.2 RDW-12.7 Plt ___\n___ 07:54AM BLOOD WBC-8.2 RBC-2.94* Hgb-9.3* Hct-29.1* \nMCV-99* MCH-31.8 MCHC-32.0 RDW-12.8 Plt ___\n \n___ 3:50 am BLOOD CULTURE #2. \n\n Blood Culture, Routine (Preliminary): \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. \n Isolated from only one set in the previous five days. \n SENSITIVITIES PERFORMED ON REQUEST..\n\n Aerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN CLUSTERS. \n \nRemainder of survellience cultures were negative \n \nPortable Abd xray: ___\nIMPRESSION: Metallic stent within the stomach compatible with \nmigration of an esophageal stent similar in position to the \nprior episode of stent migration from ___. \n \nCxr: ___\nIMPRESSION: \n1. Mild cardiac decompensation. \n2. Known migration of an esophageal stent projecting in the \nexpected region of the stomach. \n \nEGD: ___\nGastric and duodenal evaluation via gastrostomy site - small \nantral ulcer seen. Previously migrated stent seen in the \nstomach. Successful dilation of the esophagael stricture to 24 \nFR.\n \nGJ Tube Placement, ___: ___\nIMPRESSION: Uncomplicated replacement of old ___ MIC GJ \ntube tip that was coiled within the stomach with a similar but \nnew tube with its tip in the jejunum. Tube is ready for use. \n \nCXR: ___\nIMPRESSION: \n1. Opacification of the left lower lobe which, in the right \nclinical setting, is consistent with early pneumonia. \n2. Intraperitoneal free air which may represent post-surgical \nchanges from \nthe patient's recent open gastrotomy. \n \nWound Culture\n___ 8:44 pm SWAB Source: midline abd incision. \n \n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). \n \n WOUND CULTURE (Final ___: \n KLEBSIELLA PNEUMONIAE. SPARSE GROWTH. \nSENSITIVITIES: MIC expressed in MCG/ML\n _________________________________________________\n KLEBSIELLA PNEUMONIAE\n | \nAMPICILLIN/SULBACTAM-- =>32 R\nCEFAZOLIN------------- =>64 R\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- =>64 R\nCEFTRIAXONE----------- =>64 R\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n \n ANAEROBIC CULTURE (Preliminary): RESULTS PENDING. \n \nDischarge Labs:\n___ 07:24AM BLOOD WBC-6.9 RBC-3.05* Hgb-9.8* Hct-30.2* \nMCV-99* MCH-31.9 MCHC-32.3 RDW-12.9 Plt ___\n___ 07:24AM BLOOD Plt ___\n___ 07:24AM BLOOD Glucose-115* UreaN-57* Creat-4.0* Na-140 \nK-3.8 Cl-96 HCO3-32 AnGap-16\n___ 07:24AM BLOOD Calcium-9.8 Phos-3.9 Mg-2.8*\nMedical Course:\n \nASSESSMENT: ___ y/o male with cerebral palsy, ESRD on HD, \nesophageal strictures ___ GERD previously dilated by GI, \nesophageal stent that migrated to stomach, who presents with \ncoffee ground emesis due to an upper GI bleed. \n \n# Upper GI bleed: In ED pt had coffee ground emesis/lavage. Pt \nwas hemodynamically stable, started on PPI drip and transferred \nto the floor. On the floor, pt was transfused two units RBC and \nremained hemodynamically stable. His hematocrit remained \nstable. EGD revealed small gastric ulcer, migrated esophageal \nstent, but no definitive source of bleed. His stricture was \nre-dilated during EGD. Surgery was consulted for laproscopic \nremoval of esophageal stent. He was then transferred to the \nsurgical service.\n \n# Hypotension: On presentation, pt was hypotensive in ED. \nLikely secondary to intravascular volume depletion. His \npressures responded appropriately to IV fluid bolus and pt \nremained normotensive. Initially, pt was worked up for \ninfectious etiology and received several doses of IV Abx. \nInfectious workup was negative and antibiotic tx was stopped. \n \n# ESRD on HD: Pt was dialyzed per regular ___ schedule. He was \ndischarged on all HD supplements and medications. \n \n# Seizure disorder: Pt continued to receive his anticonvulsants \nduring hospitalization. He did not experience any epileptic \nactivity during hospital course. \n \n# Hypertension: stable, chronic. Was discharged on all home \nmedications. \n \n# Asthma: stable, chronic. Pt was continued on home \nmedications. He did not experience any exacerbations of asthma \nduring hospital course. \n \n \nSurgical Course:\nThe patient was admitted to the ___ surgery service on \n___ and had a lap converted to open retrieval of a migrated \nesophageal stent via duodenotomy. Post operatively, on POD 6 \nthe patient's wound started draining purulent, serosanguinous \nfluid. The wound culture grew Klebsiella (see results) \nsusceptible to Cefepime so the patient was started on this \nantibiotic and he improved nicely.\n \nNeuro: Post-operatively, the patient received Dilaudid IV with \ngood effect and adequate pain control. He complained of very \nminimal pain during this admission. The patient also complained \nof nausea intermittently. On one occasion he did vomit a brown \ncolored liquid. His G-Tube was then opened and put to gravity \nwhich drained a similar fluid and from this point on he didn't \ncomplain of nausea. The G-tube was left to gravity with minimal \noutput. His antiseizure prophylaxis was continued during this \nadmission.\n \nCV: The patient had one episode of hypotension on POD 7 \nfollowing Hemodialysis. He was given a 1 L fluid bolus with \nnice return of SBP. Other than this incident he was stable from \na CV standpoint. At baseline the patient has faint peripheral \npulses (see PE).\n \nPulmonary: Pulmonary toilet including incentive spirometry and \nearly ambulation were encouraged. The patient was stable from a \npulmonary standpoint; vital signs were routinely monitored. We \ndid obtain a CXR as part of his fever work-up that showed \npossible PNA in the LLL in the right clinical context. Because \nhe was not clinically showing other signs of PNA we did not make \nthis formal diagnosis. However, he did receive several days of \nVanc/Cipro and was sent on Cefepime as part of his wound \ninfection treatment.\n \nGI/GU: Post-operatively, the patient was given IV fluids until \nhis tube feeds were well tolerated. Post operatively his G/J \ntube was noted to be coiled in his stomach. ___ was consulted \nand they readvanced this tube into his jejunem. He was slowly \nincreased back to his home regimen of tube feeds (60mL/hr of \nNepro Full strength for 18 hours at a time). ___ was removed \non POD#1. Intake and output were closely monitored. He did not \nhave any bloody stools or bloody drainage from his G-tube during \nhis stay on the surgical service. He was constipated at times \nduring this admission and he was started on an aggressive bowel \nregimen including Bisacodyl PR with good result (BM every ___ \ndays).\n \nID: On POD 3 (from first surgery) the patient had some low grade \nfevers. On POD 4 he continued to have low grade fevers and his \nmidline incision wound was noted to be tender to palpation and \nerythematous. He was started on cephalexin for wound infection. \n Because of his questionable penicillin allergy a test dose was \nfirst given and when no side effects were noted he was then put \non a scheduled dosing cycle. On POD 5 his temperature peaked at \n101.1. Cxr showed possible early PNA but he did not have any \nclinical correlation in this arena. On POD 6 his white count \nwas 10.3, T 98.8 and he was not complaining of abdominal pain \nbut his wound started draining purulent fluid. He was taken \nback to the OR for ex lap to fix a fascial dehiscence, washout, \nand definitively address the wound infection. Following the \nsurgery the wound culture grew out Klebsiella sensitive to \ncefepime. He was started on and sent with a 2 week course of \ncefepime. Since starting this AB he has had no signs of \nsystemic infection. 2 days prior to d/c he was diagnosed with a \npenile fungal infection and started on miconazole powder.\n \nFEN: Patient has ESRD. Electrolytes were routinely monitored \nand he received dialysis on a MWF schedule without complication \n(including morning of d/c). He has a right upper extremity \nfistula as well as a midline. His midline did not show any \nsigns of external infection.\n \nProphylaxis: The patient received subcutaneous heparin during \nthis stay on the surgical service once he no longer had any GI \nbleeding. The nursing staff also tried to get the patient out \nof bed on a daily basis but was only successful on one occasion \nbecause he vehemently refused activity, preferring to sleep.\n \nAt the time of discharge on ___, the patient was doing \nwell, afebrile with stable vital signs, tolerating tube feeds \nand pain was well controlled."}}
|
{'final_diagnoses': ['Upper Gastrointestinal Bleed', 'End Stage Renal Disease', 'Wound Dehiscence', 'Dislodged Esophageal Stent s/p removal', 'Wound infection s/p exploratory lapartomy with washout', 'Seizure Disorder', 'Hypertension', 'Depression', 'Asthma'], 'procedures': ['___: Esophageal stent removal via gastrotomy.', '___: Exploratory laparotomy with fascial closure for fascial \ndehiscence.'], 'visit_summary': "Medical Course:\n \nASSESSMENT: ___ y/o male with cerebral palsy, ESRD on HD, \nesophageal strictures ___ GERD previously dilated by GI, \nesophageal stent that migrated to stomach, who presents with \ncoffee ground emesis due to an upper GI bleed. \n \n# Upper GI bleed: In ED pt had coffee ground emesis/lavage. Pt \nwas hemodynamically stable, started on PPI drip and transferred \nto the floor. On the floor, pt was transfused two units RBC and \nremained hemodynamically stable. His hematocrit remained \nstable. EGD revealed small gastric ulcer, migrated esophageal \nstent, but no definitive source of bleed. His stricture was \nre-dilated during EGD. Surgery was consulted for laproscopic \nremoval of esophageal stent. He was then transferred to the \nsurgical service.\n \n# Hypotension: On presentation, pt was hypotensive in ED. \nLikely secondary to intravascular volume depletion. His \npressures responded appropriately to IV fluid bolus and pt \nremained normotensive. Initially, pt was worked up for \ninfectious etiology and received several doses of IV Abx. \nInfectious workup was negative and antibiotic tx was stopped. \n \n# ESRD on HD: Pt was dialyzed per regular ___ schedule. He was \ndischarged on all HD supplements and medications. \n \n# Seizure disorder: Pt continued to receive his anticonvulsants \nduring hospitalization. He did not experience any epileptic \nactivity during hospital course. \n \n# Hypertension: stable, chronic. Was discharged on all home \nmedications. \n \n# Asthma: stable, chronic. Pt was continued on home \nmedications. He did not experience any exacerbations of asthma \nduring hospital course. \n \n \nSurgical Course:\nThe patient was admitted to the ___ surgery service on \n___ and had a lap converted to open retrieval of a migrated \nesophageal stent via duodenotomy. Post operatively, on POD 6 \nthe patient's wound started draining purulent, serosanguinous \nfluid. The wound culture grew Klebsiella (see results) \nsusceptible to Cefepime so the patient was started on this \nantibiotic and he improved nicely.\n \nNeuro: Post-operatively, the patient received Dilaudid IV with \ngood effect and adequate pain control. He complained of very \nminimal pain during this admission. The patient also complained \nof nausea intermittently. On one occasion he did vomit a brown \ncolored liquid. His G-Tube was then opened and put to gravity \nwhich drained a similar fluid and from this point on he didn't \ncomplain of nausea. The G-tube was left to gravity with minimal \noutput. His antiseizure prophylaxis was continued during this \nadmission.\n \nCV: The patient had one episode of hypotension on POD 7 \nfollowing Hemodialysis. He was given a 1 L fluid bolus with \nnice return of SBP. Other than this incident he was stable from \na CV standpoint. At baseline the patient has faint peripheral \npulses (see PE).\n \nPulmonary: Pulmonary toilet including incentive spirometry and \nearly ambulation were encouraged. The patient was stable from a \npulmonary standpoint; vital signs were routinely monitored. We \ndid obtain a CXR as part of his fever work-up that showed \npossible PNA in the LLL in the right clinical context. Because \nhe was not clinically showing other signs of PNA we did not make \nthis formal diagnosis. However, he did receive several days of \nVanc/Cipro and was sent on Cefepime as part of his wound \ninfection treatment.\n \nGI/GU: Post-operatively, the patient was given IV fluids until \nhis tube feeds were well tolerated. Post operatively his G/J \ntube was noted to be coiled in his stomach. ___ was consulted \nand they readvanced this tube into his jejunem. He was slowly \nincreased back to his home regimen of tube feeds (60mL/hr of \nNepro Full strength for 18 hours at a time). ___ was removed \non POD#1. Intake and output were closely monitored. He did not \nhave any bloody stools or bloody drainage from his G-tube during \nhis stay on the surgical service. He was constipated at times \nduring this admission and he was started on an aggressive bowel \nregimen including Bisacodyl PR with good result (BM every ___ \ndays).\n \nID: On POD 3 (from first surgery) the patient had some low grade \nfevers. On POD 4 he continued to have low grade fevers and his \nmidline incision wound was noted to be tender to palpation and \nerythematous. He was started on cephalexin for wound infection. \n Because of his questionable penicillin allergy a test dose was \nfirst given and when no side effects were noted he was then put \non a scheduled dosing cycle. On POD 5 his temperature peaked at \n101.1. Cxr showed possible early PNA but he did not have any \nclinical correlation in this arena. On POD 6 his white count \nwas 10.3, T 98.8 and he was not complaining of abdominal pain \nbut his wound started draining purulent fluid. He was taken \nback to the OR for ex lap to fix a fascial dehiscence, washout, \nand definitively address the wound infection. Following the \nsurgery the wound culture grew out Klebsiella sensitive to \ncefepime. He was started on and sent with a 2 week course of \ncefepime. Since starting this AB he has had no signs of \nsystemic infection. 2 days prior to d/c he was diagnosed with a \npenile fungal infection and started on miconazole powder.\n \nFEN: Patient has ESRD. Electrolytes were routinely monitored \nand he received dialysis on a MWF schedule without complication \n(including morning of d/c). He has a right upper extremity \nfistula as well as a midline. His midline did not show any \nsigns of external infection.\n \nProphylaxis: The patient received subcutaneous heparin during \nthis stay on the surgical service once he no longer had any GI \nbleeding. The nursing staff also tried to get the patient out \nof bed on a daily basis but was only successful on one occasion \nbecause he vehemently refused activity, preferring to sleep.\n \nAt the time of discharge on ___, the patient was doing \nwell, afebrile with stable vital signs, tolerating tube feeds \nand pain was well controlled.", 'medications_prescribed': ['1. carbamide peroxide 6.5 % Drops Sig: One (1) drop Otic at \nbedtime. ', '2. Balmex ___ % Cream Sig: One (1) application to buttocks \nTopical once a ___. ', '3. simethicone 40 mg/0.6 mL Drops, Suspension Sig: 1.2 mL PO \nthree times a ___ as needed for pain. ', '4. citalopram 10 mg/5 mL Solution Sig: Forty (40) mg PO at \nbedtime. ', '5. Nexium Packet 20 mg Susp,Delayed Release for Recon Sig: \nTwenty (20) mg PO once a ___. ', '6. scopolamine base 1.5 mg Patch 72 hr Sig: 1.5 Patch 72 hrs \nTransdermal Q72 HRS (). ', '7. clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly \nTransdermal QTUES (every ___. ', '8. hyoscyamine sulfate 0.125 mg Tablet, Sublingual Sig: One (1) \nTablet Sublingual once a ___. ', '9. cortisone 1 % Cream Sig: One (1) application Topical twice a \n___ as needed for itching. ', '10. acetaminophen 650 mg/20.3 mL Solution Sig: Six Hundred Fifty \n(650) mg PO every six (6) hours as needed for pain. ', '11. capsaicin 0.025 % Cream Sig: One (1) Appl Topical DAILY \n(Daily) as needed for back, knee pain. ', '12. bisacodyl 10 mg Suppository Sig: Ten (10) mg Rectal QOD. ', '13. lactulose 10 gram/15 mL Solution Sig: Ten (10) grams PO \ntwice a ___ as needed for constipation. ', '14. hydrocortisone 2.5 % Cream Sig: One (1) application Topical \ntwice a ___ as needed for pain. ', '15. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \n___ INH Inhalation every six (6) hours as needed for shortness \nof breath or wheezing. ', '16. oxcarbazepine 300 mg/5 mL Suspension Sig: 7.5 mL PO twice a \n___. ', '17. zonisamide 100 mg Capsule Sig: One (1) Capsule PO once a \n___. ', '18. calcium acetate Oral', '19. Diastat AcuDial ___ mg Kit Sig: Ten (10) mg Rectal once \na ___ as needed for seizures. ', '20. oxycodone 5 mg/5 mL Solution Sig: Five (5) mL PO every four \n(4) hours as needed for pain: To be given through GJ tube. \nPlease hold for sedation. Do not drive while using this \nmedication.\nDisp:*0 mL* Refills:*0*', '21. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a ___: \nPlease take this medication while taking narcotic pain \nmedication to prevent constipation.\nDisp:*0 Capsule(s)* Refills:*0*', '22. cefepime in D5W 1 gram/50 mL Piggyback Sig: One (1) gram \nIntravenous once a ___: Take through ___. ', '23. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical BID \n(2 times a ___.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 53, 'gender': 'M', 'symptoms': 'This is a ___ year old male on coumadin who was found after an\nunwitnessed fall with left arm and face weakness', 'medical_history': ['Hypertension', 'hypercholesterolemia', 'atrial fibrillation', 'history of left leg surgery many years prior', 'vasectomy', 'skin cancers removed'], 'family_history': 'NC', 'present_illness': "Mr. ___ is an ___ year old right handed gentleman on\ncoumadin for atrial fibrillation who was in his usual state of\nhealth until approximately 2 weeks ago. At this point he was\nhospitalized for pneumonia and came out of rehabilitation last\nweek on ___. His son whom he lives with was concerned that\nhe seemed a bit confused on ___ after getting his morning\nmedications (metoprolol and atenolol). After this continued to\nhappen intermittently, his son took him back to the hospital on\n___. At this point atenolol was stopped, and the patient was\nstarted on oral levaquin again for pneumonia. Yesterday his son\nnoted that he seemed uncoordinated with his left arm and this \nwas\nmore noticeable this morning. Around noon his father's left \nface\nwas drooping and his speech was a bit slurred. Mr. ___\nson went to work from noon to 4pm and when he returned he found\nthe patient on the floor in the bedroom where he had fallen. \nThe\nfall was unwitnessed and it is unknown if there was any LOC.\n\nMr. ___ was brought to ___ and found to have\nbilateral subdural hematomas, right greater than left on head \nCT.\nHe was given 2 units of FFP and 10 of vitamin K for reversal of\ncoumadin and transferred to ___ for further management. \n\nIn the ED here at ___, he was at first confused but oriented x\n2 and cooperative with exam. He then became unresponsive with\nrightward eye deviation and right arm twitching. He was \nurgently\nintubated and taken for a stat head CT.", 'medications': [{'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', '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': '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', 'route': 'PO', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 2.0}, {'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': 'Eptifibatide', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': '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': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', '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': 'Fentanyl Citrate', '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': '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': 'Expired', 'route': 'PO', 'frequency': 'ONCE', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY16', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Midazolam', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '379', 'valuenum': 379.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', 'valuenum': 0.25, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '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': '8.4', 'valuenum': 8.4, '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': '3832', 'valuenum': 3832.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': 'GREATER THAN 500.'}, {'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': '104', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.71, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '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': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.17', 'valuenum': 5.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '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': '26.3', 'valuenum': 26.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4404', 'valuenum': 4404.0, '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': 'GREATER THAN 500.'}, {'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': '321', 'valuenum': 321.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3002', 'valuenum': 3002.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': 'GREATER THAN 500.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.53, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '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': '51.1', 'valuenum': 51.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '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': '281', 'valuenum': 281.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.08', 'valuenum': 5.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '___', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYZED, GROSSLY.'}, {'value': '___', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYZED, GROSSLY.'}, {'value': '83.5', 'valuenum': 83.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1382', 'valuenum': 1382.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '199', 'valuenum': 199.0, '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': '89', 'valuenum': 89.0, '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': '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': '4.1', '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': '___', 'valuenum': 5.7, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.3', 'valuenum': 40.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', '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': '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': '39.7', 'valuenum': 39.7, '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': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, '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': '268', 'valuenum': 268.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '56.3', 'valuenum': 56.3, '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': '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': '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': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', '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': '139', 'valuenum': 139.0, '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': '42.0', 'valuenum': 42.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '35.8', 'valuenum': 35.8, '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': '296', 'valuenum': 296.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.91', 'valuenum': 4.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On the day of admission:\nINITIAL PHYSICAL EXAM:\nO: T: 99.2 BP: 160/63 HR:86 R 15 O2Sats 100% on RA\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: PERRL. EOMs: restricted leftward gaze otherwise\nintact (neglect?)\nNeck: Supple.\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused.\nNeuro: \nMental status: Awake and alert, somewhat confused. Rambling at\ntimes. Agitated.\nOrientation: Oriented to person, and date. Guessed "doctor\'s\noffice" for place.\nLanguage: Speech fluent with some occasional dysarthria.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4.5 to 4\nmm bilaterally. \nIII, IV, VI: Extraocular movements intact bilaterally except\nrestricted left ward gaze. \nV, VII: Left facial droop present at rest and with maximum\neffort.\nVIII: Hearing intact to voice.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Unable to test for drift. Patient moved his left arm\nspontaneously at least anti-gravity but would not follow \ncommands\nin the left arm. He was full strength and following commands in\nthe right arm and bilateral lower extremities.\n\nSensation: Left arm numbness - did not respond to noxious\nstimulation.\n\nHandedness - Right\n\nExam after intubation: Both pupils 2mm and nonreactive, midline. \n\n+cough. No corneals. BUE with increased tone, flexed, but no\nresponse to painful stimulation. BLE no response to painful\nstimulation.\n\nOn the day of discharge: \nA&O x2, PERRL, EOMI, face symmetrical,\nNo drift, MAE with good strength. \nIncision healed and scabbed.', 'diagnoses': [{'icd_code': '41011', 'desc': 'Acute myocardial infarction of other anterior wall, initial episode of care'}, {'icd_code': '42821', 'desc': 'Acute systolic heart failure'}, {'icd_code': '4271', 'desc': 'Paroxysmal ventricular tachycardia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': "___ 08:19PM GLUCOSE-123* LACTATE-2.0 NA+-132* K+-4.0 \nCL--99 TCO2-22\n___ 08:15PM LIPASE-20\n___ 08:15PM cTropnT-<0.01\n___ 08:15PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 08:15PM WBC-16.0* RBC-3.79* HGB-12.4* HCT-37.3* \nMCV-98 MCH-32.9* MCHC-33.4 RDW-13.4\n___ 08:15PM ___ PTT-30.4 ___\n___ 08:15PM ___\n WBC RBC Hgb Hct MCV MCH MCHC RDW \n Plt Ct \n___ 04:58 13.1* 3.23* 10.5* 32.7* 101* 32.5* 32.1 \n15.4 436 \n\n___ CT HEAD:\nThere is a right subdural layering along the right lateral \nconvexity and along the right tentorium. Mixed density of this \nhematoma is concerning for continued bleeding. Hematoma the \nmaximum depth of 2.2 cm in its wall. This hematoma causes 1.5 cm \nof midline shift at the level of the lateral \nventricles. There is mild effacement of the right aspect of the \nsuprasellar cistern, but the basal cisterns remain patent. There \nis no acute infarction, mass or midline shift. There is no \nhydrocephalus. The ventricles and sulci are mildly prominent, \nconsistent with age-related atrophy. Periventricular white \nmatter hypodensities are nonspecific but consistent with small \nvessel ischemic changes. There is mild mucosal thickening of the \nanterior ethmoid air \ncells polypoid mucosal thickening of the left maxillary sinus. \nThe remainder of the visualized paranasal sinuses and mastoid \nair cells are clear. There is no fracture. \n \n___ CT HEAD:\n1. Status post right frontoparietal craniotomy with evacuation \nof right \nsubdural hemorrhage. Small right subdural collection with a \nsmall amount of subdural hemorrhage layering along the right \ntentorium. No midline shift. \n2. New apparent small right temporal intraparenchymal \nhemorrhage. \n \n___ MRI Brain\nIMPRESSION: \n1. Small acute or early subacute infarctions in the right medial \nfrontal \ncortex and in the subcortical/deep white matter of the right \nparacentral \nlobule. \n2. Small extra-axial hematoma deep to the right craniotomy, \nsmall right \nsubdural fluid collection, small subdural hematoma along the \nright tentorium, small parenchymal hematoma in the anterior \nright temporal lobe, subarachnoid hemorrhage in the right \noccipital sulci, and small subdural hematoma along the left \nparietal/ occipital convexity, all of which are stable compared \nto ___ CT. No significant mass effect. \n3. Chronic punctate microhemorrhages at the gray/ white matter \njunction of the right parietal lobe, which may be related to \namyloid angiopathy in a patient of this age. \n \n___ CT Head\nIMPRESSION: \nStatus post right frontoparietal craniotomy with evacuation of \nright subdural hemorrhage with persistent right subdural \nhemorrhage identified layering along the right tentorium \nunchanged in extent. Bifrontal isodense subdural collections as \nbefore. No significant mass effect. \nUnchanged small right temporal intraparenchymal hemorrhage. \n\n___ LENIS\nIMPRESSION: \nNo evidence of deep venous thrombosis in the bilateral lower \nextremity veins.\nAs stated in the HPI Mr. ___ had a rapid deterioration in \nthe emergency room and was re-scanned and found to have a larger \nSubdural hematoma, he was intubated and taken to the OR for \nemergent evacuation early in the morning. He underwent a right \ncraniotomy for subdural evacuation and subgaleal drain \nplacement. He was transported to the ICU intubated. He remained \nminimally responsive initially, but was more ineractive on \nmorning rounds, able to follow commands briskly with his right \nside. Given his previous symptoms and persistant left sided \ndefecits and neglect an MRI was obtained to r/o stroke. He was \ntachycardiac requiring Adenosine and his heart rate lowered and \nAflutter could be seen. He received Amiodorone bolus and drip. \nHe was then cardioverted. Patient was on neo, dilt, esmolol, and \namiodorone. \n\nOn ___, he had better rate control on Amiodorone, but \ncontinued on esmolol and levophed drips intermittantly. He was \nrestarted on SQ Heparin. He spiked a temperature to 103 and a \nWBC jump to 19. Mini BAL was sent which were negative for \norganism growth. His urine was negaive for infection. He had a \nMRI which showed early subactue infarcts in the right medial \nfrontal cortex and in the subcortical/deep white matter of the \nright paracentral lobule.\n\n___, Mr. ___ neurological exam improved. He started to \nfollow commands in bilateral lower extremities as well as \nbriskly in his right upper extremity. He continued to only \nwithdraw the left upper. He was started on standing metoprolol. \n\n___, Mr. ___ remained neurologically stable. He continued \nto be intubated because of copious secretions.\n\n___, the patient had two witnesses seizures which were broken \nwith ativan. Neuro epilepsy was consulted and he was placed on \nEED. A non-contrast HCT was obtained which showed no acute \nintracranial processes. His Keppra was re-loaded and increased \nto 1000mg twice a day.\n\n___: Mr. ___ did not have any seizures overnight, but \nperiods of discharges near area of intracranial blood. Epilepsy \nsuggested increasing Keppra to 1500 BID. He was bronched in \neffort to assess sputum in prep for extuabtion and then \nextubated. LENIS showed no evidence of DVT.\n\n___, the continuous EEG shows three subclinical seizures. He \nwas started on Dilantin. \n\n___, he continued to be seizure free on EEG and clinically. \nThe EEG was discontinued and he was transferred to the floor on \ntelemetry. Speech and swallow evaluated the patient and felt he \nwas likely aspirating. They suggested continued tube feeds with \nstrict NPO. Physical therapy evaluated the patient and \ndispositioned him to rehab. \n\n___, patient was tachycardiac to 110-150's, BP 93/56, and had \none episode in the AM of RR in ___ with good O2 sats. Medicine \nwas consulted to take a overall look. CXR appeared stable and \nlabs were ok.\n\n___ Staples were removed from surgical incision. Incision is \nc/d/i. Re-evaluated by speech and swallow and failed swallow \nstudy. ACS was consulted for PEG placement \n\n___- Alert and oriented x3, ACS reccomendations included to \nallow the patient more time and trial for oral diet given he was \nextubated a short time ago, foley catheter replaced. \n\n___- The patients exam remained stable. The patient \nconsistently followed commands. PERRL with EOMs intact. \n\n___ and swallow consult reccomended strict NPO. \n\n___ patient was alert and oriented to person place and \ntime. The patient followed simple commands and moved all \nextremities with grossly full motor strength. The patient did \nnot follow a detailed motor exam. The patients pupils were equal \nround and reactive to light with extra ocular movements intact. \nThe patient exhibited slight left facial droop and left pronator \ndrift. The patient continued to refuse PEG placement. Case \nmanagment spoke with the patient's son who is the patient's \nhealth care proxy and his son stated he would be in to speak to \nthe patient and medical staff regarding PEG placement. speech \ntherapy consulted and the patient's diet was advanced from NPO \nto puree solids/nectar liquids. The patient was mobilized out \nof bed to the chair. The patients dilantin level was 14 the \npatients digoxin level was 0.7.\nOn ___ he remained stable and disposition planning continued. \nHowever the patient became more sleepy on exam. The patient \nheart rate went into afib intermitently, an EKG was obtained, \ncardiac enzymes and troponins were sent and were negative. His \ncorrected dilantin level was 14.3, a medicine consult was \nobtained for afib and recommended nothing to do, just rate \ncontrolled.\nOn ___ the patient remained stable, no PEG needed. The patient \nis being screened for rehab, case management will look into a \nrehab were the patient could go with dobhoff with cycle tube \nfeeds.\nOn ___, cycle tube feeds were initiated via dobhoff, his diet \nwas changed to thin liquids and TID ensures. He got up from his \nchair with no assistance and fell on his butt, did not hit his \nhead. On exam after his fall he was moving all extremities \nwithout difficulty or pain with ROM. His coumadin and aspirin \nwere put on hold secondary to his SDH and craniotomy for \nevacuation, he may resume his aspirin, but coumadin will remain \non hold indefinately. The patient was discharge to rehab in \nstable conditions."}}
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{'final_diagnoses': ['Bilateral subdural hematomas', 'Dysphagia', 'VAP', 'Tachycardia', 'Afib and Aflutter', 'Pulmonary edema'], 'procedures': ['right craniotomy for ___ evacuation'], 'visit_summary': "As stated in the HPI Mr. ___ had a rapid deterioration in \nthe emergency room and was re-scanned and found to have a larger \nSubdural hematoma, he was intubated and taken to the OR for \nemergent evacuation early in the morning. He underwent a right \ncraniotomy for subdural evacuation and subgaleal drain \nplacement. He was transported to the ICU intubated. He remained \nminimally responsive initially, but was more ineractive on \nmorning rounds, able to follow commands briskly with his right \nside. Given his previous symptoms and persistant left sided \ndefecits and neglect an MRI was obtained to r/o stroke. He was \ntachycardiac requiring Adenosine and his heart rate lowered and \nAflutter could be seen. He received Amiodorone bolus and drip. \nHe was then cardioverted. Patient was on neo, dilt, esmolol, and \namiodorone. \n\nOn ___, he had better rate control on Amiodorone, but \ncontinued on esmolol and levophed drips intermittantly. He was \nrestarted on SQ Heparin. He spiked a temperature to 103 and a \nWBC jump to 19. Mini BAL was sent which were negative for \norganism growth. His urine was negaive for infection. He had a \nMRI which showed early subactue infarcts in the right medial \nfrontal cortex and in the subcortical/deep white matter of the \nright paracentral lobule.\n\n___, Mr. ___ neurological exam improved. He started to \nfollow commands in bilateral lower extremities as well as \nbriskly in his right upper extremity. He continued to only \nwithdraw the left upper. He was started on standing metoprolol. \n\n___, Mr. ___ remained neurologically stable. He continued \nto be intubated because of copious secretions.\n\n___, the patient had two witnesses seizures which were broken \nwith ativan. Neuro epilepsy was consulted and he was placed on \nEED. A non-contrast HCT was obtained which showed no acute \nintracranial processes. His Keppra was re-loaded and increased \nto 1000mg twice a day.\n\n___: Mr. ___ did not have any seizures overnight, but \nperiods of discharges near area of intracranial blood. Epilepsy \nsuggested increasing Keppra to 1500 BID. He was bronched in \neffort to assess sputum in prep for extuabtion and then \nextubated. LENIS showed no evidence of DVT.\n\n___, the continuous EEG shows three subclinical seizures. He \nwas started on Dilantin. \n\n___, he continued to be seizure free on EEG and clinically. \nThe EEG was discontinued and he was transferred to the floor on \ntelemetry. Speech and swallow evaluated the patient and felt he \nwas likely aspirating. They suggested continued tube feeds with \nstrict NPO. Physical therapy evaluated the patient and \ndispositioned him to rehab. \n\n___, patient was tachycardiac to 110-150's, BP 93/56, and had \none episode in the AM of RR in ___ with good O2 sats. Medicine \nwas consulted to take a overall look. CXR appeared stable and \nlabs were ok.\n\n___ Staples were removed from surgical incision. Incision is \nc/d/i. Re-evaluated by speech and swallow and failed swallow \nstudy. ACS was consulted for PEG placement \n\n___- Alert and oriented x3, ACS reccomendations included to \nallow the patient more time and trial for oral diet given he was \nextubated a short time ago, foley catheter replaced. \n\n___- The patients exam remained stable. The patient \nconsistently followed commands. PERRL with EOMs intact. \n\n___ and swallow consult reccomended strict NPO. \n\n___ patient was alert and oriented to person place and \ntime. The patient followed simple commands and moved all \nextremities with grossly full motor strength. The patient did \nnot follow a detailed motor exam. The patients pupils were equal \nround and reactive to light with extra ocular movements intact. \nThe patient exhibited slight left facial droop and left pronator \ndrift. The patient continued to refuse PEG placement. Case \nmanagment spoke with the patient's son who is the patient's \nhealth care proxy and his son stated he would be in to speak to \nthe patient and medical staff regarding PEG placement. speech \ntherapy consulted and the patient's diet was advanced from NPO \nto puree solids/nectar liquids. The patient was mobilized out \nof bed to the chair. The patients dilantin level was 14 the \npatients digoxin level was 0.7.\nOn ___ he remained stable and disposition planning continued. \nHowever the patient became more sleepy on exam. The patient \nheart rate went into afib intermitently, an EKG was obtained, \ncardiac enzymes and troponins were sent and were negative. His \ncorrected dilantin level was 14.3, a medicine consult was \nobtained for afib and recommended nothing to do, just rate \ncontrolled.\nOn ___ the patient remained stable, no PEG needed. The patient \nis being screened for rehab, case management will look into a \nrehab were the patient could go with dobhoff with cycle tube \nfeeds.\nOn ___, cycle tube feeds were initiated via dobhoff, his diet \nwas changed to thin liquids and TID ensures. He got up from his \nchair with no assistance and fell on his butt, did not hit his \nhead. On exam after his fall he was moving all extremities \nwithout difficulty or pain with ROM. His coumadin and aspirin \nwere put on hold secondary to his SDH and craniotomy for \nevacuation, he may resume his aspirin, but coumadin will remain \non hold indefinately. The patient was discharge to rehab in \nstable conditions.", 'medications_prescribed': ['1. Artificial Tear Ointment 1 Appl BOTH EYES PRN irritated \nsclera/conjunctiva', '2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation', '3. Chlorhexidine Gluconate 0.12% Oral Rinse 15 ml ORAL BID', '4. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol', '5. Digoxin 0.1875 mg PO DAILY', '6. Docusate Sodium (Liquid) 100 mg PO BID', '7. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol', '8. Glucose Gel 15 g PO PRN hypoglycemia protocol', '9. Heparin 5000 UNIT SC TID', '10. Insulin SC \n Sliding Scale\n\nFingerstick q6h\nInsulin SC Sliding Scale using REG Insulin', '11. LeVETiracetam Oral Solution 1500 mg PO BID', '12. Metoprolol Tartrate 50 mg PO Q6H', '13. Phenytoin (Suspension) 100 mg PO Q8H', '14. Senna 8.6 mg PO BID:PRN Constipation', '15. Miconazole Powder 2% 1 Appl TP QID:PRN Groin/perineal rash', '16. Aspirin 81 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 42, 'gender': 'M', 'symptoms': 'transfer for hypotension on pressors, intubated', 'medical_history': ['HCV', 'cirrhosis', 'hemochromatosis', 'h/o IVDU', 'h/o EtOH abuse', 'Low Back Pain'], 'family_history': 'Father (Alive) etoh abuse; htn \nMother (Alive) some type of cancer', 'present_illness': 'man with a PMHx sig cirrhosis, HCV, hemachromotosis, prior \nEtOH / IVDU use. 2 days prior to presentation at ___, he woke \nup in the morning feeling well. He went to work; ___ hours \nlater, he left work early with nausea, vomiting, diarrhea, and \nshaking chills. He subsequently developed testicular pain then \npresented to the ED with pressures as low as 55/40. He was \ntaken to the OR urgently on the morning of ___ for a right \nochiectomy and left orchiopexy. Per report, the testicle was \nischemic but not necrotic. Minimal blood loss was noted in the \nOP report. However, postoperatively he was transferred to the \nICU for hypotension on dopamine, norepinephrine, and \nvasopressin. His bp was noted to remain with maps of 60-70 \ndespite approximately 10L of IV fluid. At this time he was also \nnoted to be in anuric ARF. Additionally, he received 10units of \nplatelets and 2 units of FFP due to thrombocytopenia. His \nlactate during this period hit a zenith of 12, with a \nprogressive decrease to ___ with resuscitation. He was \ntransferred to ___ for further care.\n.\nAt the ___, he continued to be hypotensive on three pressors; \nlabs were drawn and revealed WBC count of 40, with 43 bands, \nlactate of 6, and pH of 7.1. Potassium was 6.7, HCO3 of 16, \namylase was 2500. New renal failure with creatinine of 4.3 and \nUOP of 50 cc/hr. Thrombocyotpenia to 38. Given high lactate, \nhigh amylase without high lipase, absence of bowel sounds, and \nnoted blood in stool, general surgery was consulted for question \nof ischemic bowel. Scrotum was noted to be dark in color with \nedema; urology was consulted to help exclude ___ \nGangrene. Abdominal and pelvic torso was ordered. Pressors were \ncontinued; lasix was administered along with calcium gluconate, \nmetolazone, sodium bicarbonate, insulin and D5. Sedation was \ncontinued.', 'medications': [{'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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prasugrel', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, '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': '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': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '90', 'valuenum': 90.0, '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': 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': '4.93', 'valuenum': 4.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '284', 'valuenum': 284.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, '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': '42.3', 'valuenum': 42.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '246', 'valuenum': 246.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.67', 'valuenum': 4.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, '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': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\nVitals: temp 101.4, HR 120, BP 90/60, 98% on 100% FiO2 ASSIST \nControl\nGen: sedated and intubated, with aberrant dysrhythmic breathing\nCardiac: RRR, no murmurs appreciable\nPulm: Lungs clear bilaterally in ant lung fields\nAbd: no bowel sounds present, soft abdomen, no erythema evident, \nnondistended\nExt: scrotal edema with dark-purplish scrotum, surrouding mild \nerythema along perineum\nRectum: bright red blood per rectum mixed with stool\n\nDISCHARGE EXAM\npatient expired', 'diagnoses': [{'icd_code': 'T82857A', 'desc': 'Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter'}, {'icd_code': 'I25110', 'desc': 'Atherosclerotic heart disease of native coronary artery with unstable angina pectoris'}, {'icd_code': 'I472', 'desc': 'Ventricular tachycardia'}, {'icd_code': 'I2582', 'desc': 'Chronic total occlusion of coronary artery'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'Y92019', 'desc': 'Unspecified place in single-family (private) house as the place of occurrence of the external cause'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R0789', 'desc': 'Other chest pain'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}], 'summary': "___ 07:49PM BLOOD WBC-40.1*# RBC-4.07*# Hgb-13.1*# \nHct-37.6*# MCV-92 MCH-32.2* MCHC-34.8 RDW-13.8 Plt Ct-38*#\n___ 07:49PM BLOOD Neuts-49* Bands-43* ___ Monos-6 \nEos-0 Baso-0 ___ Metas-1* Myelos-1*\n___ 07:49PM BLOOD ___ PTT-56.1* ___\n___ 07:49PM BLOOD Glucose-66* UreaN-53* Creat-4.3*# Na-136 \nK-6.7* Cl-106 HCO3-16* AnGap-21*\n___ 07:49PM BLOOD ALT-61* AST-126* LD(LDH)-639* AlkPhos-60 \nAmylase-2321* TotBili-5.4*\n___ 07:49PM BLOOD Albumin-2.2* Calcium-6.3* Phos-7.7* \nMg-1.8\n___ 08:20PM BLOOD Lactate-5.8*\n\nMICRO DATA:\n___ BLOOD CULTURE - [pending]\n___ URINE URINE CULTURE - negative \n___ BLOOD CULTURE - [pending]\n___ PERITONEAL FLUID GRAM STAIN-FINAL; FLUID \nCULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY INPATIENT \n___ SWAB GRAM STAIN-FINAL; WOUND CULTURE-FINAL \n{STAPHYLOCOCCUS, COAGULASE NEGATIVE}; ANAEROBIC \nCULTURE-PRELIMINARY INPATIENT \n___ STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B TEST- \nnegative \n___ BLOOD CULTURE Blood Culture, Routine-PENDING \n___ BLOOD CULTURE - [pending]\n___ BLOOD CRYPTOCOCCAL ANTIGEN - negative \n___ URINE Legionella Urinary Antigen - [pending]\n___ SPUTUM GRAM STAIN - FINAL; RESPIRATORY \nCULTURE-PRELIMINARY; Immunoflourescent test for Pneumocystis \njirovecii (carinii)- negative\n___ HIV-1 Viral Load [pending]\n___ 12:00PM BLOOD B-GLUCAN-[pending]\n___ 12:00PM BLOOD HCV Ab-[pending]\n___ 09:57AM BLOOD HIV Ab-[pending]\n___ BLOOD CULTURE [pending]\n___ BLOOD CULTURE [pending]\n\nCXR ___\nCardiac size is top normal. ET tube is in standard position. The \nNG tube tip is in the stomach. Right IJ catheter tip is in the \nmid SVC. There are large multifocal consolidations, worse in the \nlower lobe, right greater than left, consistent with multilobar \npneumonia. There is no pneumothorax or pleural effusion. \n\nRUQ U/S ___\nNo evidence of acute cholecystitis. Gallbladder wall thickening \nis nonspecific in the setting of ascites. Echos in the \ngallbladder could \nsludge or small nonshadowing stones. \n\nCT CHEST/ABD/PELVIS W/O CONTRAST ___\n1. Large bilateral consolidations at the lung bases with \nadditional patchy \nareas of opacities involving mid and upper lung zones, \nconcerning for \nmultifocal pneumonia. \n2. Marked gallbladder wall thickening, may be related to its \nunderdistension and ascites. Hyperattenuating material within \nthe gallbladder lumen, represents vicarious excretion of \ncontrast, which obscures small amount of sludge and small \ngallstones as seen on ultrasound exam of ___. \n3. Moderate amount of fluid is seen tracking from the scrotal \nsac into the \nretroperitoneum in the right perirenal space, which is most \nlikely \npostsurgical in nature. \n4. Marked atrophy of the left kidney, may be congenital or be \nrelated to \nprior infection or infarction. \n5. Mild compression deformity of the L5 vertebral body of \nindeterminate \nchronicity. \n\nSCROTAL U/S ___\nNo definite evidence of ___ gangrene. Multiple foci of \nair within the perineum which appears to be continuous with the \nprevious \noperative wound site. If concern persists, consider reimaging in \none to two days. \n\nTTE ___\nThe left atrium is mildly dilated. No atrial septal defect is \nseen by 2D or color Doppler. Left ventricular wall thickness, \ncavity size, and global systolic function are normal (LVEF>55%). \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. \nThere is no mitral valve prolapse. The pulmonary artery systolic \npressure could not be determined. There is a trivial/physiologic \npericardial effusion. There are no echocardiographic signs of \ntamponade. \n\nCT CHEST/ABD/PELVIS WITH CONTRAST ___ [prelim read]\n1. Interval development of diffusely abnormally thickened large \nbowel \ninvolving nearly all of the large bowel with relative sparing of \nthe rectum. The appearances are most suggestive of an infectious \ncolitis e.g C. Difficile. Ischaemia is considered less likely \ngiven the extent of involvement and the patent splanchnic \nvessels. \n2. Bibasal lower lobe consolidations, unchanged compared to the \nprior study.\n3. Focal hypoenhancing area in segment V/VI of the liver is \nindeterminate \nbased on today's study but may be due to post-biopsy change or \nnecrosis. \n4. Diffuse hyperenhancement of the myocardium of uncertain \nclinical significance. \n5. Possible infarct in the upper pole of the spleen.\nMr. ___ is a ___ gentleman with cirrhosis (hemochromatosis, \nHCV, prior EtOH) who presented to an OSH with hypotension and \ntesticular pain, underwent right orchiectomy for torsion, and \nwas transferred to the ___ MICU for profound septic shock. \n\nThe source of infection and his severe systemic sepsis syndrome \nwas unclear; he was evaluated for testicular infection, \n___ gangrene, biliary infection, pneumonia, bacterial \nperitonitis, cellulitis, etc. ACS, Urology, and I.D. were \nfollowing. He was covered broadly with \nVancomycin/Meropenem/Levofloxacin (Metronidazole was stopped as \nhe had negative C.diff). \n\nHis course was marked by profound hypotension requiring four \npressors (dopamine, levophed, vasopressin, and phenylephrine) \nthroughout his hospitalization (with a fifth pressor \n[epinephrine] added on ___, and multiorgan failure \n(respiratory failure, DIC, hepatic injury, renal failure \nrequiring CVVH, suspected ischemic colitis and ileus with \nperitonitis). Despite maximal medical care for sepsis, he \ncontinued to deteriorate throughout his hospitalization, \ncharacterized by increasing pressor requirements, steadily \nincreasing lactate (6 to 8 to 10 to 13), progressive liver \nfailure (characterized by rising AST, ALT, bilirubin), worsening \nrespiratory failure (requiring increasing FiO2 at the end of his \nhospitalization), and renal failure requiring RRT. \n\nOf note, his family (wife and daughters) were present on rounds \nevery day during his hospitalization and were kept up-to-date on \nhis clinical course with frequent up-dates and family meetings. \nThey were informed of (and endorsed understanding of) his \nextremely high likelihood of dying during this hospitalization \ngiven the severity of his multiorgan failure. \n\nOn ___, his exam demonstrated loss of brainstem function as he \nhad newly noted fixed and dilated pupils, no gag reflex, no \ncough reflex (to deep suctioning), no corneal reflex, and a \nnegative occulocephalic reflect. STAT CT head revealed cerebral \nedema. Neurosurgery was consulted for consideration of placing \nan ICP monitor, but given his thrombocytopenia and coagulopathy \ncoupled with his overall progressive systemic deterioration, the \ndecision was made not to pursue placement of an ICP monitor. \n\nThroughout the course of the day on ___, the previously steady \nbut consistent deterioration of his blood pressure became more \nrapid, as he became progressively hypotensive on maximal doses \nof five pressors. A family meeting was held with his wife \n(health care proxy) and daughter, and the consensus decision was \nmade to withdraw care given his markedly worsening neurologic \nstatus and his overall systemic deterioration. All family \nmembers were in agreement with the decision to withdraw support \ngiven his negligible likelihood of surviving his acute illness. \nIn concert with his family's wishes, his care was transitioned \nto CMO, and he expired at 8:00PM with family and friends at the \nbedside."}}
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{'final_diagnoses': ['patient expired'], 'procedures': ['left IJ triple lumen central venous line', 'rterial line', 'temporary hemodialysis catheter placement', 'CVVH'], 'visit_summary': "Mr. ___ is a ___ gentleman with cirrhosis (hemochromatosis, \nHCV, prior EtOH) who presented to an OSH with hypotension and \ntesticular pain, underwent right orchiectomy for torsion, and \nwas transferred to the ___ MICU for profound septic shock. \n\nThe source of infection and his severe systemic sepsis syndrome \nwas unclear; he was evaluated for testicular infection, \n___ gangrene, biliary infection, pneumonia, bacterial \nperitonitis, cellulitis, etc. ACS, Urology, and I.D. were \nfollowing. He was covered broadly with \nVancomycin/Meropenem/Levofloxacin (Metronidazole was stopped as \nhe had negative C.diff). \n\nHis course was marked by profound hypotension requiring four \npressors (dopamine, levophed, vasopressin, and phenylephrine) \nthroughout his hospitalization (with a fifth pressor \n[epinephrine] added on ___, and multiorgan failure \n(respiratory failure, DIC, hepatic injury, renal failure \nrequiring CVVH, suspected ischemic colitis and ileus with \nperitonitis). Despite maximal medical care for sepsis, he \ncontinued to deteriorate throughout his hospitalization, \ncharacterized by increasing pressor requirements, steadily \nincreasing lactate (6 to 8 to 10 to 13), progressive liver \nfailure (characterized by rising AST, ALT, bilirubin), worsening \nrespiratory failure (requiring increasing FiO2 at the end of his \nhospitalization), and renal failure requiring RRT. \n\nOf note, his family (wife and daughters) were present on rounds \nevery day during his hospitalization and were kept up-to-date on \nhis clinical course with frequent up-dates and family meetings. \nThey were informed of (and endorsed understanding of) his \nextremely high likelihood of dying during this hospitalization \ngiven the severity of his multiorgan failure. \n\nOn ___, his exam demonstrated loss of brainstem function as he \nhad newly noted fixed and dilated pupils, no gag reflex, no \ncough reflex (to deep suctioning), no corneal reflex, and a \nnegative occulocephalic reflect. STAT CT head revealed cerebral \nedema. Neurosurgery was consulted for consideration of placing \nan ICP monitor, but given his thrombocytopenia and coagulopathy \ncoupled with his overall progressive systemic deterioration, the \ndecision was made not to pursue placement of an ICP monitor. \n\nThroughout the course of the day on ___, the previously steady \nbut consistent deterioration of his blood pressure became more \nrapid, as he became progressively hypotensive on maximal doses \nof five pressors. A family meeting was held with his wife \n(health care proxy) and daughter, and the consensus decision was \nmade to withdraw care given his markedly worsening neurologic \nstatus and his overall systemic deterioration. All family \nmembers were in agreement with the decision to withdraw support \ngiven his negligible likelihood of surviving his acute illness. \nIn concert with his family's wishes, his care was transitioned \nto CMO, and he expired at 8:00PM with family and friends at the \nbedside.", 'medications_prescribed': ['patient expired']}
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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': 'foot swelling, AMS', 'medical_history': ['1. Osteoporosis, currently on calcium and vitamin D2.', '2. Acute ischemic stroke in ___, which presented with \ndysarthria and right-sided weakness in her arm greater than her \nleg.', '3. Dementia, positive advanced small vessel ischemic disease \nseen on CTA in ___.', '4. Gait disorder. The patient is nonambulatory, uses a \nwheelchair, is total assist for transfers.', '5. Hyperlipidemia, currently on atorvastatin.', '6. History of delirium.'], 'family_history': "Both her parents died in their ___ and had\nAlzheimer's disease. There is no known family history of \ncancer.", 'present_illness': 'Ms. ___ is an ___ with PMH of osteoporosis, h/o acute \nischemic stroke ___ c/b dysarthria and right sided arm > leg \nweakness, vascular dementia, gait disorder, HL, h/o delirium who \npresents with right foot swelling. Patient was sent to be \nevaluated for DVT for R foot swelling over the past week. She \ndenies any fever, chills, chest pain, shortness breath. She is a \nvery poor historian however. Her daughter is here with her and \nstates that the patient lives in an ___ facility \nwith very good service.\n In the ED, initial vitals: 98.6 84 117/77 18 97% RA \n - Exam notable for: \n - Labs notable for: whole blood K 4.0, lactate 1.4, normal \nchemistry, WBC 10.1, UA with +leuk, +nitrite, BNP 545 \n - Imaging notable for: ___ w/o DVT, CXR w/o acute process, \nFoot xray w/o fracture or dislocation \n - Patient given: ceftriaxone 1g IV x1 \n - Vitals prior to transfer: 97.8 76 138/79 18 96% RA \n On arrival to the floor, pt reports feeling well. Unable to \nprovide further history. \n REVIEW OF SYSTEMS: (+) per HPI, all other ROS otherwise \nnegative', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', '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': 'BuPROPion XL (Once Daily)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', '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': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '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': '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': 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': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': 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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.24', 'valuenum': 1.24, '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': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, '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': '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75.6', 'valuenum': 75.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, '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': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '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': '0.12', 'valuenum': 0.12, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.84', 'valuenum': 0.84, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.00', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, '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': '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': '109.7', 'valuenum': 109.7, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, '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': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '234', 'valuenum': 234.0, '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': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': None, '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': '44.9', 'valuenum': 44.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.13', 'valuenum': 0.13, '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': '___', '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\n Vitals: 97.4 128 / 68 67 18 94 RA \n General: no acute distress \n HEENT: Sclera anicteric, MMM, oropharynx clear \n Lungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \n CV: RRR, normal S1 + S2, no murmurs, rubs, gallops \n Abdomen: soft, non-tender, non-distended, bowel sounds present \n\n Ext: Warm, well perfused, !+ nonpiting edema on R > L leg, with \nDP 2+ bilaterally \n Skin: Without rashes or lesions \n Neuro: right sided weakness, dysarthric speech\n\nDISCHARGE EXAM\nVITALS: 97.5 128-133/67-68 63-67 18 95RA \nGENERAL: no distress, oriented to name only, unable to say \nmonths of year backwards \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nNECK: Supple, JVP not elevated, no LAD \nRESP: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nABD: +BS, soft, nondistended, nontender to palpation. No \nhepatomegaly. \nGU: no foley \nEXT: no edema noted; ___ is somewhat spastic and patient unable \nto fully strengthen leg', 'diagnoses': [{'icd_code': 'L03115', 'desc': 'Cellulitis of right lower limb'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}], 'summary': "___ 03:00PM BLOOD WBC-10.1* RBC-4.37 Hgb-13.7 Hct-42.7 \nMCV-98 MCH-31.4 MCHC-32.1 RDW-13.1 RDWSD-46.8* Plt ___\n___ 03:00PM BLOOD Glucose-99 UreaN-15 Creat-0.6 Na-135 \nK-7.0* Cl-100 HCO3-27 AnGap-15\n___ 03:00PM BLOOD proBNP-545\n___ 06:34AM BLOOD Calcium-9.0 Phos-3.8 Mg-2.1\n___ 04:34PM BLOOD K-4.06\n___ 05:27PM BLOOD Lactate-1.4\n\nDISCHARGE LABS\n___ 06:34AM BLOOD WBC-10.0 RBC-4.17 Hgb-12.7 Hct-39.8 \nMCV-95 MCH-30.5 MCHC-31.9* RDW-12.9 RDWSD-45.7 Plt ___\n___ 06:34AM BLOOD Glucose-68* UreaN-12 Creat-0.6 Na-143 \nK-4.1 Cl-103 HCO3-27 AnGap-17\n\nMICRO\nBCx ___ PND\nUCx ___ PND\n\nIMAGING\nR Foot Xray\nNo acute fracture or dislocation.\n\n___\nNo evidence of deep venous thrombosis in the right common \nfemoral, femoral and popliteal veins. \nDue to inability of the patient to straighten her leg, the \npatient's posterior tibial and peroneal veins could not be be \nevaluated. \n\nCXR \nLimited exam without definite acute cardiopulmonary process.\n___ yo F with history of ischemic stroke and vascular dementia \nwho presents with altered mental status in setting of positive \nUA."}}
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{'final_diagnoses': ['Toxic metabolic encephalopathy', 'UTI'], 'procedures': ['None'], 'visit_summary': '___ yo F with history of ischemic stroke and vascular dementia \nwho presents with altered mental status in setting of positive \nUA.', 'medications_prescribed': ['1. Cefpodoxime Proxetil 100 mg PO Q12H \nRX *cefpodoxime 100 mg 1 tablet(s) by mouth twice a day Disp \n#*11 Tablet Refills:*0', '2. ABC Plus (multivit-min-FA-lycopen-lutein) 0.4-300-250 \nmg-mcg-mcg oral DAILY', '3. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild', '4. Aspirin 81 mg PO DAILY', '5. Atorvastatin 40 mg PO QPM', '6. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 \nmg(1,500mg) -400 unit oral DAILY', '7. Guaifenesin-Dextromethorphan 10 mL PO TID', '8. nystatin 100,000 unit/gram topical BID:PRN', '9. Senna 8.6 mg PO DAILY:PRN constipation']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 34, 'gender': 'M', 'symptoms': 'Chest Pain', 'medical_history': ['CAD s/p 3 stents ___', 'HYPERTENSION', 'HYPERLIPIDEMIA', 'ANXIETY', 'CHRONIC LOW BACK PAIN', 'OSA ON CPAP', 'GERD', 'NEPHROLITHIASIS S/P RENAL STENT', 'S/P KNEE SURGERY', 'HX OF ASBESTOS EXPOSURE'], 'family_history': 'Family history of cardiovascular disease, specifically history \nof MI in father.', 'present_illness': 'This is a ___ year old man with multiple cardiac risk factors \nincluding HTN, HL, CAD s/p STENT X 3 in ___ who was scheduled \nfor cath in ___ but is transferred from an OSH with an acute \nepisode of CP, now with plans for coronary angiogram by Dr. \n___ in the AM. \n The patient reports that he developed a pressure-like pain in \nhis chest with radiation down his L arm. He also had \nlightheadedness, shortness of breath, nausea and diaphoresis. He \ntook two aspirin and nitro without relief, along with a \nKlonopin. He has had several weeks of SOB but no CP with \nexertion during this period. This has occurred in the setting of \n___ episodes over the past 6 months in which he has the \nsensation his throat is closing and lightheadedness. He usually \ntakes Clonazepam for these symptoms. \n While at ___, patient had an EKG that showed SR with no acute \nST-T changes. Also with CXR with no abnormality. Most recent \nprior chest imaging there was a CT on ___ that demonstrated \nno PE. He was given Dilaudid and remained pain free for the rest \nof his ED course. Per OSH report, his Troponin trend was <0.015 \n/ 0.043 / 0.029. Vitals prior to transfer were HR 70, RR 16, BP \n125/79, 97% on RA.', 'medications': [{'medication': 'Aspirin', '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}]}, 'clinical_findings': {'labs': [{'value': '43.4', 'valuenum': 43.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '400', 'valuenum': 400.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '4.0', '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': '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': '___', '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', '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': '33.5', 'valuenum': 33.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVITALS: 97.6F 130/89 72 16 100%RA \n GENERAL: no apparent distress, sleeping in bed \n HEENT: NC/AT, no scleral icterus, PERRLA, EOMI \n NECK: supple \n CARDIAC: RRR, normal S1/S2, no murmurs \n PULMONARY: clear to auscultation bilaterally, without wheezes \n ABDOMEN: soft, non-tender, non-distended \n EXTREMITIES: warm, well-perfused, no ___ edema. \n NEUROLOGIC: A&Ox3, CN II-XII grossly normal \n\nDISCHARGE EXAM:\nVITALS: T98.2 BP 124/79 (108-134/53-88) HR79 (64-74) RR18 \nSaO295%RA \n GENERAL: no apparent distress, sleeping in bed \n HEENT: NC/AT, no scleral icterus, PERRLA, EOMI \n NECK: supple \n CARDIAC: RRR, normal S1/S2, no murmurs \n PULMONARY: clear to auscultation bilaterally, without wheezes \n ABDOMEN: soft, non-tender, non-distended \n EXTREMITIES: warm, well-perfused, no ___ edema. Wrist without \nbleeding or bruising \n NEUROLOGIC: A&Ox3, no focal deficits', 'diagnoses': [{'icd_code': '7851', 'desc': 'Palpitations'}, {'icd_code': '79431', 'desc': 'Nonspecific abnormal electrocardiogram [ECG] [EKG]'}], 'summary': 'LABS:\n___ 07:45AM BLOOD WBC-7.6 RBC-4.56* Hgb-13.8 Hct-41.1 \nMCV-90 MCH-30.3 MCHC-33.6 RDW-12.3 RDWSD-40.2 Plt ___\n___ 05:45AM BLOOD WBC-7.3 RBC-4.38* Hgb-13.1* Hct-39.8* \nMCV-91 MCH-29.9 MCHC-32.9 RDW-12.3 RDWSD-41.3 Plt ___\n___ 07:45AM BLOOD ___ PTT-32.0 ___\n___ 07:45AM BLOOD Glucose-84 UreaN-24* Creat-1.3* Na-139 \nK-4.5 Cl-101 HCO3-28 AnGap-15\n___ 05:45AM BLOOD Glucose-81 UreaN-21* Creat-1.3* Na-140 \nK-4.3 Cl-103 HCO3-29 AnGap-12\n___ 07:45AM BLOOD cTropnT-<0.01\n___ 07:45AM BLOOD Calcium-9.4 Phos-4.0 Mg-2.2\n___ 05:45AM BLOOD Calcium-9.4 Phos-3.7 Mg-2.1\n\nIMAGING/REPORTS:\nCATH REPORT: PENDING\nThis is a ___ year old man with multiple cardiac risk factors \nincluding HTN, HL, CAD s/p STENT X 3 in ___ who was scheduled \nfor cath in ___ but is transferred from an OSH with an acute \nepisode of CP for coronary angiogram.\n\n#NSTEMI: While at ___, patient had an EKG that showed SR with \nno acute ST-T changes. Also with CXR with no abnormality. Most \nrecent prior chest imaging there was a CT on ___ that \ndemonstrated no PE. He was given Dilaudid and remained pain free \nfor the rest of his ED course. Per OSH report, his Troponin \ntrend was <0.015 / 0.043 / 0.029. He received a cardiac cath \nwhich showed 90% occlusion of D1 and a DES was placed without \ncomplication. His atorvastatin was increased to 80 mg and he was \ncontinued on home aspirin, Plavix and metoprolol \n#HYPERTENSION: Cont home metoprolol\n#CAD/HYPERLIPIDEMIA: \n - Continued home aspirin 81mg daily \n - Continued home Plavix 75mg daily \n#CHRONIC LOW BACK PAIN \n - Continued home Percocet q8H PRN for pain \n -DISCONTINUED celecoxib as not recommended in someone with \nknown ischemic cardiac disease/CAD.\n#ANXIETY: \n - Continued home Clonazepam ___ BID PRN \n#OSA: \n - Continued home CPAP'}}
|
{'final_diagnoses': ['NSTEMI', 'CAD', 'HTN', 'HLD', 'Low back pain'], 'procedures': ['___ cardiac cath via radial artery'], 'visit_summary': 'This is a ___ year old man with multiple cardiac risk factors \nincluding HTN, HL, CAD s/p STENT X 3 in ___ who was scheduled \nfor cath in ___ but is transferred from an OSH with an acute \nepisode of CP for coronary angiogram.\n\n#NSTEMI: While at ___, patient had an EKG that showed SR with \nno acute ST-T changes. Also with CXR with no abnormality. Most \nrecent prior chest imaging there was a CT on ___ that \ndemonstrated no PE. He was given Dilaudid and remained pain free \nfor the rest of his ED course. Per OSH report, his Troponin \ntrend was <0.015 / 0.043 / 0.029. He received a cardiac cath \nwhich showed 90% occlusion of D1 and a DES was placed without \ncomplication. His atorvastatin was increased to 80 mg and he was \ncontinued on home aspirin, Plavix and metoprolol \n#HYPERTENSION: Cont home metoprolol\n#CAD/HYPERLIPIDEMIA: \n - Continued home aspirin 81mg daily \n - Continued home Plavix 75mg daily \n#CHRONIC LOW BACK PAIN \n - Continued home Percocet q8H PRN for pain \n -DISCONTINUED celecoxib as not recommended in someone with \nknown ischemic cardiac disease/CAD.\n#ANXIETY: \n - Continued home Clonazepam ___ BID PRN \n#OSA: \n - Continued home CPAP', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM\nRX *atorvastatin 80 mg 1 tablet(s) by mouth every evening Disp \n#*30 Tablet Refills:*0', 'ClonazePAM 0.5-1 mg PO BID:PRN anxiety', 'Clopidogrel 75 mg PO DAILY', 'Nitroglycerin SL 0.4 mg SL Q5MIN:PRN CP', 'Oxycodone-Acetaminophen (5mg-325mg) 2 TAB PO Q4H:PRN PAIN', 'Metoprolol Succinate XL 25 mg PO BID', 'potassium citrate 20 mEq tab oral BID', 'Ranitidine 300 mg PO BID:PRN heartburn']}
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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': '"I get manic in the fall."', 'medical_history': ['none active'], 'family_history': 'Maternal grandfather with ___. Father with depression. Pt \ndenies h/o suicides in family.', 'present_illness': '___ yo female ___ at ___ with history of \ndepression and hypomanic episodes sent to ED from ___\n___ further evaluation of an acute manic episode. On \npresentation to the ED, the pt exhibited pressured speech, \nracing thoughts, excess energy and paranoid delusions about her \ncomputor at school being hacked into, one of her roommates being \na mole for ___ and a sense that ___ in general is \nnot a safe place for me." These symptoms had been escalating \nsince ___ with the patient staying at her parents home. \nShe was started on olanzapine and a sertraline taper by her \noutpt psychiatrist and returned to school the day before \nadmission. The day of presentation to the ED she had been sent \nto the ___ by a professor secondary to concern \nabout her manic and paranoid symptoms.', 'medications': [{'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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amlodipine', '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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Codeine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '13', 'valuenum': 13.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '179', 'valuenum': 179.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 88.0, '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': 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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 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': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': '>1.050*.'}, {'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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'POS', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}, {'value': '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': '9.5', 'valuenum': 9.5, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 287.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.30', 'valuenum': 4.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'WD, WN caucasian female in NAD.\nHead: NCAT\nEyes: PERRL\nEars: clear tympanic membranes, nml light reflex\nNose: nares patent\nMouth: moist mucosal membranes, good dentition\nHeart: RRR, no M/G/R\nLungs: CTA Bilaterally\nAbdomen: soft, NTND\nExtremeties: no CCE 2+ DP\nNeuro exam intact with no abnormalities', 'diagnoses': [{'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '4373', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': '30570', 'desc': 'Amphetamine or related acting sympathomimetic abuse, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '78194', 'desc': 'Facial weakness'}, {'icd_code': '72889', 'desc': 'Other disorders of muscle, ligament, and fascia'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}], 'summary': "___ 06:25PM GLUCOSE-82 UREA N-10 CREAT-0.5 SODIUM-137 \nPOTASSIUM-4.0 CHLORIDE-102 TOTAL CO2-27 ANION GAP-12\n___ 06:25PM estGFR-Using this\n___ 06:25PM ALT(SGPT)-50* AST(SGOT)-44* ALK PHOS-61 TOT \nBILI-0.2\n___ 06:25PM CHOLEST-218*\n___ 06:25PM TRIGLYCER-110 HDL CHOL-63 CHOL/HDL-3.5 \nLDL(CALC)-133*\n___ 06:25PM TSH-1.7\n___ 06:25PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 06:25PM URINE HOURS-RANDOM\n___ 06:25PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 06:25PM WBC-8.2 RBC-4.05* HGB-12.3 HCT-35.5* MCV-88 \nMCH-30.2 MCHC-34.5 RDW-13.3\n___ 06:25PM NEUTS-56.3 ___ MONOS-5.6 EOS-3.7 \nBASOS-0.5\n___ 06:25PM PLT COUNT-420\n___ 06:25PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 06:25PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\nPt was admitted to Deaconess ___ on a conditional voluntary basis. \n She was continued on her outpt medication regimen and \nsertraline had been discontinued in the emergency room. \nMedication options for long term mood stabilization were \ndiscussed ___ and Lamictal) and pt felt that \nLamictal was the best option for her. Risks and side effects \nwere explained to pt (and pts mother in phone conversation), \nincluding risk ___ and pt voiced \nunderstanding. She was started on Lamictal 25 mg daily with no \nadverse effect. She also utilized ativan 1 mg nod prn for \nepisodes on anxiety.\n\nDuring her stay, the pt remained in behavioral control. She \nparticipated in both individual and group therapy and was an \nactive member in her discharge planning. While improvement was \nnoted in her energy level, thought process and rapidity in \nspeech, the delusions persisted. However, the pt was able to \nengage in some reality testing around them. On the day of \ndischarge she was not suicidal or homicidal, was attending to \nher ADL's and requesting discharge. Given that she appeared at \nno apparent acute risk of harm to self or others, it was felt \ndischarge was appropriate. The pt and her parents were in \nagreement with this plan. Her outpt psychiatrist, Dr. ___, \nwas also notified and felt the treatment plan was appropriate."}}
|
{'final_diagnoses': ['Axis I - Bipolar Disorder, manic with psychotic features', 'Axis II - none', 'Axis III - no active issues'], 'procedures': ['none'], 'visit_summary': "Pt was admitted to Deaconess ___ on a conditional voluntary basis. \n She was continued on her outpt medication regimen and \nsertraline had been discontinued in the emergency room. \nMedication options for long term mood stabilization were \ndiscussed ___ and Lamictal) and pt felt that \nLamictal was the best option for her. Risks and side effects \nwere explained to pt (and pts mother in phone conversation), \nincluding risk ___ and pt voiced \nunderstanding. She was started on Lamictal 25 mg daily with no \nadverse effect. She also utilized ativan 1 mg nod prn for \nepisodes on anxiety.\n\nDuring her stay, the pt remained in behavioral control. She \nparticipated in both individual and group therapy and was an \nactive member in her discharge planning. While improvement was \nnoted in her energy level, thought process and rapidity in \nspeech, the delusions persisted. However, the pt was able to \nengage in some reality testing around them. On the day of \ndischarge she was not suicidal or homicidal, was attending to \nher ADL's and requesting discharge. Given that she appeared at \nno apparent acute risk of harm to self or others, it was felt \ndischarge was appropriate. The pt and her parents were in \nagreement with this plan. Her outpt psychiatrist, Dr. ___, \nwas also notified and felt the treatment plan was appropriate.", 'medications_prescribed': ['1. Olanzapine 7.5 mg Tablet Sig: Two (2) Tablet PO HS (at \nbedtime).\nDisp:*60 Tablet(s)* Refills:*1*', '2. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed.\nDisp:*14 Tablet(s)* Refills:*0*', '3. Lamotrigine 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*14 Tablet(s)* Refills:*0*']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'hemorrhoid pain', 'medical_history': ['hemorrhoids', 'Past surgical history is remarkable for his repair of a deviated\nseptum.'], 'family_history': "Family history is remarkable for patient's father having died \ndue\nto an MI.", 'present_illness': 'Mr. ___ is a ___ gentleman who is status \npost\nexamination under anesthesia, excision of likely mucosal polyp,\nand three-position hemorrhoidectomy on ___ ___. \nThe patient presents today for urgent visit\nsecondary to intractable pain. He reports that he took the half\nbottle of magnesium citrate and did have a successful bowel\nmovement; however, after the bowel movement, he started to note\nincreasing pain to the point where today, he is unable to sit,\nand it is ___ pain..\n\nUpon examination today, he is an alert and oriented young\ngentleman who appears to be in a fair amount of discomfort. He\nis walking with a shuffling gait and is unable to sit on the \nexam\ntable. Upon placing this patient in the left lateral decubitus\nposition, he was noted to have three areas of swelling. These\nareas were purplish blue in color and exquisitely tender to\ntouch. Dr. ___ was in clinic at that time and was able to\nassess this patient. It was determined that the best course of\naction for this patient would be to take him to the operating\nroom to excise a probable thrombosed hemorrhoid. The patient \nwas\nplaced on call and was assisted over to ___, pending\noperative procedure.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': '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': '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pulmicort Flexhaler', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'INHALATION', 'frequency': 'BID', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': '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': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mg/dL', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POS.'}, {'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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, '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': '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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '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': 216.0, 'valueuom': 'mg/dL', '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, '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': '85', 'valuenum': 85.0, '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': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'AFVSS\n\nGen: AOx3, NAD\nCV: RRR s1s2 nl no MRG\nResp: CTAB no w/r/r\nabd: soft NTND bs+ \next: wwp, no cce, pppx4\nrectal: multiple sutures with non-erythematous wounds around the \nanal verge', 'diagnoses': [{'icd_code': '59080', 'desc': 'Pyelonephritis, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': 'none\nAfter tolerating his hemorrhoidectomy well, the pt started a \nregular diet and took oral pain medications. He slept well and \ncontinued to eat and have no pain issues. He was discharged \nhome.'}}
|
{'final_diagnoses': ['Thrombosed hemorrhoid'], 'procedures': ['Excision of thrombosed hemorrhoids'], 'visit_summary': 'After tolerating his hemorrhoidectomy well, the pt started a \nregular diet and took oral pain medications. He slept well and \ncontinued to eat and have no pain issues. He was discharged \nhome.', 'medications_prescribed': ['1. hydrocodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nevery ___ hours as needed for pain for 2 weeks: do not drive, \noperate machinery or take tylenol while on this medication. no \nmore than 8 pills / day.\nDisp:*60 Tablet(s)* Refills:*0*', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) for 4 weeks: hold for diarrhea.\nDisp:*56 Capsule(s)* Refills:*0*', '3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) for 4 weeks.\nDisp:*56 Tablet(s)* Refills:*0*', '4. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every six (6) \nhours as needed for pain for 2 weeks: take with food. not to \nexceed 8 pills / day.\nDisp:*56 Tablet(s)* Refills:*0*']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 83, 'gender': 'M', 'symptoms': 'neck and L.arm pain', 'medical_history': ['___ ESOPHAGUS', 'COLONIC POLYPS', 'GASTROESOPHAGEAL REFLUX', 'HYPERCHOLESTEROLEMIA', 'OVARIAN CYSTS', 'ABDOMINAL PAIN', 'SPINAL STENOSIS', 'VENOUS MALFORMATION'], 'family_history': 'Other COLON CANCER \n CORONARY ARTERY DISEASE \n \nMother MYOCARDIAL INFARCTION \n \nAunt ___ CANCER \n \nOther BREAST CANCER \n UTERINE CANCER', 'present_illness': "___ y.o woman with h.o GERD, spinal stenosis/sciatica, who \npresented for evlauation of lower neck pain with radiation down \nthe entire L.arm/hand. Pt reports symptoms developed acutely \nwhile in ___ but denies any trauma. Pt reports pain has \nbeen severe ___ since onset. Pain is sharp and twisting with \npainful radiation down the arm and is worse with neck extension. \nShe has been sleeping upright due to this. She presented to \n___ in ___ and was given tylenol with codeine. She then \npresented to her son's PCP and was given dilaudid, flexeril and \ngabapentin and a medrol dose back which end 1 week ago. She \nreports that her pain has continued and the medications have \ncaused dizziness, nausea and vomiting. Reports pain x3 weeks \nwithout new changes. MRI done on ___ and cortisone injection \non ___ by Dr. ___. Pt denies fever, chills, paresthesias, \nweakness, bowel or bladder incontinence or difficulty \nevacuating. She has chronic unchanged constipation. No headache. \nShe also denies CP, sob, cough, ST, abdominal pain, diarrhea, \ndysuria, other joint pains.\n\nIn the ___, pt was given oxycodone, ketorolac, acetaminophen, \ndiazepam and zofran. ___ d/w ___ who recommended outpt f/u. \nVSS in the ___\n.", 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': '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 Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Phytonadione', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Rifaximin', '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': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', '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': 'Pravastatin', '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': 'Metoprolol Tartrate', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'Omeprazole', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'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': 'Phytonadione', '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': 'Q8H', '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': 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': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': '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': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', '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}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', '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': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 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'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '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': 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 1.4,. Estimated GFR = 48 if non African-American (mL/min/1.73 m2). Estimated GFR = 59 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'GEN: well appearing, NAD\nvitals: VSS\nHEENT: ncat eomi anicteric MMM\nneck: supple, able to move in all directions but limited \nextension\nchest: b/l ae no w/c/r\nheart: s1s2 rr no m/r/g\nabd: +bs, soft, NT, ND\next: no c/c/e 2+pulses\nneuro: face symmetric, speech fluent, ___ strength b/l UE and \n___, sensation intact to LT, no tremor\npsych: calm, cooperative', 'diagnoses': [{'icd_code': '8208', 'desc': 'Closed fracture of unspecified part of neck of femur'}, {'icd_code': '34830', 'desc': 'Encephalopathy, unspecified'}, {'icd_code': '5723', 'desc': 'Portal hypertension'}, {'icd_code': '71106', 'desc': 'Pyogenic arthritis, lower leg'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'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': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'E8889'}, {'icd_code': '45829', 'desc': 'Other iatrogenic hypotension'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '60001', 'desc': 'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '30503', 'desc': 'Alcohol abuse, in remission'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': 'MRI C ___ IMPRESSION:\n1. Enlarged left-sided disc protrusion at C6-7 since ___, now with moderate to severe left C7 foraminal stenosis. Mild\ncentral stenosis at C6-7 with slight cord impingement, and\nmoderate to severe right C7 foraminal stenosis, stable.\n2. Moderate left C5 foraminal stenosis, worse since ___.\n3. Moderate central stenosis at C5-6 with moderate cord\ndeformity and severe bilateral C6 foraminal stenosis, stable.\n4. Mild to moderate bilateral C4 foraminal stenosis, without\nchange.\n\n___ 08:25AM BLOOD WBC-4.1 RBC-3.85* Hgb-12.4 Hct-36.0 \nMCV-94# MCH-32.2* MCHC-34.4 RDW-13.6 Plt ___\n___ 08:25AM BLOOD Plt ___\n___ 08:25AM BLOOD ___ PTT-31.9 ___\n___ 08:25AM BLOOD Glucose-89 UreaN-8 Creat-0.6 Na-137 K-4.0 \nCl-102 HCO3-28 AnGap-11\n___ 08:25AM BLOOD Calcium-9.6 Phos-4.6* Mg-2.\n___ y.o woman with neck and arm pain with recent MRI revealing \ncervical stenosis\n.\n#neck and arm pain due to cervical stenosis and radiculopathy-\nShe underwent surger on ___\n.\n#constipation-bowel regimen\n Required mag citrate and mineral oil. Once home, she has a \nregimen that tends to work for her. She should curtail use of \noxycodone.\n\n#GERD-ppi\n.\n#depression-continue SSRI\n.\n#FEn-regular diet with mechanical soft diet.\n\n#code-full\n#dispo-home. '}}
|
{'final_diagnoses': ['Cervical radiculitis'], 'procedures': ['C5 to C7 anterior cervical discectomy and fusion with \ninstrumentation ___'], 'visit_summary': '___ y.o woman with neck and arm pain with recent MRI revealing \ncervical stenosis\n.\n#neck and arm pain due to cervical stenosis and radiculopathy-\nShe underwent surger on ___\n.\n#constipation-bowel regimen\n Required mag citrate and mineral oil. Once home, she has a \nregimen that tends to work for her. She should curtail use of \noxycodone.\n\n#GERD-ppi\n.\n#depression-continue SSRI\n.\n#FEn-regular diet with mechanical soft diet.\n\n#code-full\n#dispo-home. ', 'medications_prescribed': ['Citalopram 20 mg PO DAILY', 'Cyclobenzaprine 10 mg PO HS:PRN spasm', 'Gabapentin 300 mg PO TID', 'Omeprazole 20 mg PO DAILY', 'Simvastatin 20 mg PO QPM', 'Bisacodyl 10 mg PO/PR DAILY constipation \nRX *bisacodyl 5 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0', 'Diazepam 5 mg PO Q6H:PRN spasms \nRX *diazepam 5 mg 1 tablet by mouth q6 hrs Disp #*80 Tablet \nRefills:*0', 'OxycoDONE Liquid ___ mg PO Q3H:PRN pain \nRX *oxycodone 5 mg/5 mL ___ mls by mouth q4 hrs Refills:*0', 'Benefiber (guar gum) (guar gum) 1 dose ORAL DAILY', 'Celecoxib 100 mg PO BID:PRN pain \nRX *celecoxib [Celebrex] 100 mg 1 capsule(s) by mouth twice a \nday Disp #*60 Capsule Refills:*0']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'Tertiary hyperparathyroidism', 'medical_history': ['ESRD s/p cadaveric renal transplant in ___', 'h/o glomerulonephritis', 'Endometrial cancer s/p TAH and BSO', 'Hypercalcemia thought secondary to tertiary hyperparathyroidism', 'Hypertension', 'H/o bacterial sinusitis', 'Hyperlipidemia', 'Migraines'], 'family_history': 'Prostate cancer, breast cancer in the paternal grandmother and \naunt. No colon cancer. No diabetes or hypertension.', 'present_illness': 'The patient is a ___ woman who has hyperparathyroidism. \nHer MIBI scan suggests enlarged glands in the neck, but also an \nectopic focus in the mediastinum just at the takeoff of the left \nmainstem bronchus and anterior to this.', 'medications': [{'medication': 'Fluconazole', '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': 'Discontinued', 'route': 'PO', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H: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': 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': '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': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', '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', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Paroxetine', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Paroxetine', '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': 'Q4H: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', 'route': 'SC', 'frequency': 'LUNCH', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'BREAKFAST', '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': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': 'Acetaminophen', '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': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': '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': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': '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': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', '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': 'Ibuprofen', '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', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'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': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', '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': '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': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Magnesium Oxide', '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', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', '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': 'HS', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.6', 'valuenum': 0.6, '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': '43.6', 'valuenum': 43.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.8', 'valuenum': 34.8, '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': '6.2', 'valuenum': 6.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.0', 'valuenum': 84.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '327', 'valuenum': 327.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.74', 'valuenum': 4.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, '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': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, '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': '120', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 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 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '195', 'valuenum': 195.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '3.6', 'valuenum': 3.6, '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '>1000.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '1.015', 'valuenum': 1.015, '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': 14.7, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 375.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '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': '40.1', 'valuenum': 40.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '312', 'valuenum': 312.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 202.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', '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': '138', 'valuenum': 138.0, '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': '11', 'valuenum': 11.0, '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': '___'}, {'value': '644', 'valuenum': 644.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.3, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MEASURED BY ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, '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': '33.6', 'valuenum': 33.6, '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': '74.6', 'valuenum': 74.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '314', 'valuenum': 314.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '432', 'valuenum': 432.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 21.0, 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10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '21', 'valuenum': 21.0, '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': '35', 'valuenum': 35.0, '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': '7.40', 'valuenum': 7.4, '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': '31.8', 'valuenum': 31.8, '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': '30.7', 'valuenum': 30.7, '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': '94', 'valuenum': 94.0, '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': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '444', 'valuenum': 444.0, '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': '3.37', 'valuenum': 3.37, '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': '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': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', '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': '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': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, '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': '467', 'valuenum': 467.0, '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': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 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 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': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, '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': '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': 'TR.'}, {'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': '8', 'valuenum': 8.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.005', 'valuenum': 1.005, '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': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, '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': '9.8', 'valuenum': 9.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.4', 'valuenum': 82.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '436', 'valuenum': 436.0, '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': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '22.1', 'valuenum': 22.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, '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': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.1', 'valuenum': 82.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '450', 'valuenum': 450.0, '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': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.3', 'valuenum': 32.3, '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': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.3', 'valuenum': 73.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '454', 'valuenum': 454.0, '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': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '68.2', 'valuenum': 68.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, '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': '13.0', 'valuenum': 13.0, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 0.4, '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': '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': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59.9', 'valuenum': 59.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '464', 'valuenum': 464.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '480', 'valuenum': 480.0, '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': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, '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': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 50 if non African-American (mL/min/1.73 m2). Estimated GFR = 61 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '32.4', 'valuenum': 32.4, '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': '521', 'valuenum': 521.0, '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': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On day of discharge:\nTemp 98.0 HR 85 BP 116/84 RR 18 97%RA\nGen: alert and oriented x 3, NAD\n___: RRR\nPULM: CTA b/l\nABD: s/nt/nd\nIncision: c/d/i, no swelling or hematoma', 'diagnoses': [{'icd_code': '6205', 'desc': 'Torsion of ovary, ovarian pedicle, or fallopian tube'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '78959', 'desc': 'Other ascites'}, {'icd_code': '49320', 'desc': 'Chronic obstructive asthma, unspecified'}, {'icd_code': '220', 'desc': 'Benign neoplasm of ovary'}, {'icd_code': '6208', 'desc': 'Other noninflammatory disorders of ovary, fallopian tube, and broad ligament'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': '___ 05:30AM BLOOD Glucose-136* UreaN-55* Creat-4.8* Na-136 \nK-3.8 Cl-103 HCO3-19* AnGap-18\n___ 05:30AM BLOOD Calcium-7.3* Phos-5.0* Mg-2.4\n___ 08:04AM BLOOD PTH-1280*\n___ 10:02AM BLOOD PTH-245*\nThe patient was admitted to the surgical floor following \nsurgery. Her diet was advanced to a regular diet and pain \ncontrolled intially with IV pain medication. She did not have \nany hoarseness or neck swelling. Post operative PTH level \ndecreased from 1280 to 245. On POD 1 she was discharged home \ntolerating a regular diet, pain well controlled on PO \nmedication. She was started on Calcitriol 0.25 mcg q day and \nTUMS 1500 mg TID.'}}
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{'final_diagnoses': ['Tertiary hyperparathyroidism'], 'procedures': ['S/p mediastinoscopy', 'parathyroidectomy'], 'visit_summary': 'The patient was admitted to the surgical floor following \nsurgery. Her diet was advanced to a regular diet and pain \ncontrolled intially with IV pain medication. She did not have \nany hoarseness or neck swelling. Post operative PTH level \ndecreased from 1280 to 245. On POD 1 she was discharged home \ntolerating a regular diet, pain well controlled on PO \nmedication. She was started on Calcitriol 0.25 mcg q day and \nTUMS 1500 mg TID.', 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN pain ', '2. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB ', '3. Amlodipine 7.5 mg PO DAILY \nhold if SBP<100, HR<60 ', '4. CycloSPORINE (Neoral) MODIFIED 50 mg PO DAILY ', '5. Furosemide 20 mg PO DAILY ', '6. Losartan Potassium 50 mg PO BID ', '7. Mycophenolate Mofetil 500 mg PO BID ', '8. Nadolol 40 mg PO DAILY \nhold if SBP<100, HR<60 ', '9. Pravastatin 40 mg PO DAILY ', '10. PredniSONE 4 mg PO EVERY OTHER DAY ', '11. sevelamer CARBONATE 800 mg PO TID W/MEALS ', '12. Hydrocodone-Acetaminophen (5mg-500mg ___ TAB PO Q4H:PRN pain \n\nRX *hydrocodone-acetaminophen 5 mg-500 mg ___ Tablet(s) by mouth \nq 6 hours Disp #*40 Capsule Refills:*0', '13. Vitamin D 50,000 UNIT PO 1X/WEEK (FR) \nRX *ergocalciferol (vitamin D2) 50,000 unit 1 Capsule(s) by \nmouth once a week Disp #*8 Capsule Refills:*0', '14. Calcium Carbonate 1500 mg PO TID \nRX *calcium carbonate 500 mg calcium (1,250 mg) 3 Tablet(s) by \nmouth three times a day Disp #*90 Capsule Refills:*3', '15. Calcitriol 0.25 mcg PO DAILY \nRX *calcitriol 0.25 mcg 1 Capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*3']}
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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': 'abdominal pain, hematochezia', 'medical_history': ['# Cholangitis - secondary to biliary stricture in ___ s/p \nPTBD/dilation, now removed, stricture path benign', '# Recurrent intrahepatic biliary duct strictures ', '# Rheumatoid arthritis - severe seropositive and erosive with \nmultiple deformities; on 10mg prednisone and hydroxychloroquine ', '# Laparoscopic cholecystectomy around ___ in ___ ', '# Chronic right foot ulcer - followed by podiatry; debrided \n___ s/p foot surgery in ___ and s/p skin graft ', '# HTN ', '# Diverticulitis status post perforation and colostomy with \ncolostomy takedown in ___ ', '# SBOs requiring lysis of adhesions in ___ and ___, and more \nrecent SBO managed conservatively in ___.', '# Peripheral artery disease: ~20% carotid stenosis', '# Restrictive ventilatory defect and right diaphragmatic \nparalysis', '# Restless leg syndrome - on carbidopa-levodopa', '# Complex sleep-disordered breathing (bilevel HS ___', '# IBS ', '# Cervical spondylolysis', '# Lumbar spinal stenosis', '# Carpal tunnel syndrome', '# Right leg and foot melanoma s/p resection'], 'family_history': 'Sister with celiac disease, two aunts with liver cancer, IBS in \nthe family.', 'present_illness': "___ with hx of RA, diverticulosis s/p R hemicolectomy (___),\nchronic R foot plantar ulcer, recent discharge following\nmechanical fall sustaining multiple lacs, presents with 1 day of\nLLQ abdominal pain a/w bloody diarrhea.Symptoms started \nyesterday\nAM. She estimates > 10 loose bowel movements. Towards the end\nthere has been blood on tissue paper. LLQ pain is ___ intensity. No vomiting but some nausea currently. Able to\ntolerate PO's at home. Symptoms feels like previous\ndiverticulitis. \n\n-In the ED, initial vitals were: T 98.3 HR 100 BP 153/93 RR 18\nSpo2 95% RA \n-Exam notable for diminished breath sounds at bases, +LLQ\ntenderness, no guarding or rebound, + maroon colored stool on\nrectal exam guaiac positive, 1 external hemorrhoid, LLE \ndressings\nin place, RLE unna boot, malodorous discharge R foot dressing\nsaturated; Dressing and unna boot was removed and underlying\nulceration appears clean, non-infected \n-Labs showed WBC 14.4, H/H 12.0/38.2, K 3.2, Cr 0.9, INR 1.0,\nLFTs and lipase were unremarkable \n-Abd CT demonstrated colitis predominantly involving the sigmoid\ncolon and splenic flexure, with possible colitis versus\nunderdistention of the descending colon. \n-Received Potassium Chloride 40 mEq IV x1 \n-Transfer VS were: HR 101 BP 152/74 RR 20 SpO2 98% RA \nDecision was made to admit to medicine for further management. \n\nOn arrival to the floor, patient reports that her abdominal pain\nis mostly subsided and most severe in the LLQ. She has no\ncurrent n/v. She denies any recent sick contacts although she\nhas been living at an ALF. She has not had any recent\nantibiotics, no travel. She has had no dysuria. She denies\nhaving any orthostatic symptoms but feels quite fatigued. She\nhas no other acute medical complaints.\n\nReview of systems: \nAs per HPI, otherwise negative in detail", 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', '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': 'MoviPrep', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q1H PER MOVIPREP PROTOCOL', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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}]}, 'clinical_findings': {'labs': [{'value': '3.6', 'valuenum': 3.6, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '477', 'valuenum': 477.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '367', 'valuenum': 367.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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': '41', 'valuenum': 41.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '53.0', 'valuenum': 53.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, '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': '169', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, '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': '24', 'valuenum': 24.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '2+*.'}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.4, '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': 'abnormal', 'priority': 'ROUTINE', '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, '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': 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': '10', 'valuenum': 10.0, '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': '1.1', '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': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '18.7', 'valuenum': 18.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.66', 'valuenum': 4.66, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61.8', 'valuenum': 61.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': 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': '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': '33.0', 'valuenum': 33.0, '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': '18.3', 'valuenum': 18.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '197', 'valuenum': 197.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.64', 'valuenum': 4.64, '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': '65.5', 'valuenum': 65.5, '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, elderly female lying in bed in no \nacute\ndistress \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,\nMMdry, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: soft, midline incision c/d/I. +BS. mild ttp of LLQ\nwithout any rebound or guarding\nEXTREMITIES: Hands bilaterally with ulnar deviation and fingers\nwith ___ neck deformities. BLE wrapped with 2+ edema to knees\nwith ulcer of plantar aspect of R midfoot (wrapped)\nPULSES: 2+ DP/TP pulses bilaterally \nNEURO: AOx3, grossly nonfocal \n\nDISCHARGE PHYSICAL EXAM:\nVital Signs: 98.2, 118/73, 72, 20, 95% on RA\nI/O: no BMs o/n\nGeneral: Alert, oriented, elderly female sitting up in bed \neating\nbreakfast in no acute distress with soft collar in place \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,\nMMdry, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: soft, midline incision c/d/I. +BS. No ttp of LLQ\nwithout any rebound or guarding\nEXTREMITIES: Hands bilaterally with ulnar deviation and fingers\nwith ___ neck deformities. BLE wrapped with 2+ edema to knees\nwith ulcer of plantar aspect of R midfoot (wrapped)\nPULSES: 2+ DP/TP pulses bilaterally \nNEURO: AOx3, grossly nonfocal', 'diagnoses': [{'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6835', 'desc': 'Body mass index [BMI] 35.0-35.9, adult'}, {'icd_code': 'I25119', 'desc': 'Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris'}], 'summary': 'ADMISSION LABS\n==============\n___ 02:30AM GLUCOSE-104* UREA N-24* CREAT-0.9 SODIUM-141 \nPOTASSIUM-3.2* CHLORIDE-99 TOTAL CO2-27 ANION GAP-18\n___ 02:30AM ALT(SGPT)-<5 AST(SGOT)-22 ALK PHOS-90 TOT \nBILI-0.3\n___ 02:30AM LIPASE-44\n___ 02:30AM ALBUMIN-3.5\n___ 02:30AM WBC-14.4* RBC-3.94 HGB-12.0 HCT-38.2 MCV-97 \nMCH-30.5 MCHC-31.4* RDW-14.6 RDWSD-52.1*\n___ 02:30AM NEUTS-86.3* LYMPHS-7.6* MONOS-4.7* EOS-0.8* \nBASOS-0.2 IM ___ AbsNeut-12.43* AbsLymp-1.10* AbsMono-0.68 \nAbsEos-0.11 AbsBaso-0.03\n___ 02:30AM PLT COUNT-220\n___ 02:30AM ___ PTT-24.5* ___\n\nIMAGING\n========\nCT ABD & PELVIS WITH CO ___\nIMPRESSION: \nColitis predominantly involving the sigmoid colon and splenic\nflexure, with possible colitis versus underdistention of the\ndescending colon. This is a nonspecific finding, and can be due\nto infectious, inflammatory, or ischemic etiology. No inflamed\ndiverticulum is identified. \n\nMICROBIOLOGY\n=============\n___ BCx x 2 pending\n___ UCx negative\n___ BCx x 2 pending\n___ C. diff POSITIVE\n___ Stool cultures pending\n\nDISCHARGE LABS\n==============\n___ 06:45AM BLOOD WBC-7.5 RBC-3.46* Hgb-10.3* Hct-33.9* \nMCV-98 MCH-29.8 MCHC-30.4* RDW-14.9 RDWSD-53.9* Plt ___\n___ 06:45AM BLOOD Glucose-98 UreaN-19 Creat-0.8 Na-144 \nK-4.4 Cl-105 HCO3-29 AnGap-14\n___ 06:45AM BLOOD Calcium-8.6 Phos-3.2 Mg-1\n___ with hx of RA, diverticulosis s/p R hemicolectomy (___), \nchronic R foot plantar ulcer, recent discharge following \nmechanical fall sustaining multiple lacs, presents with 1 day of \nLLQ abdominal pain a/w bloody diarrhea found to have abd CT \nfindings concerning for colitis. \n \n# Abdominal Pain/Diarrhea. Improved. Patient presented with \nLLQ abdominal pain associated with 24 hrs of bloody diarrhea \nprior to admission. CT abdomen showed inflammatory changes of \nthe sigmoid colon and splenic flexure concerning for colitis. \nUpon admission, her diarrhea resolved. Given her improvement of \nsymptoms, antibiotics were initially held. However, stool \nculture returned C. diff positive for which she was placed on PO \nvancomycin. The patient was initially placed on bowel rest, but \nher diet was successfully advanced to a regular diet.\n \n# Hematochezia: Resolved. Patient with hematochezia in the \nsetting of diarrhea. On admission, patient hemodynamically \nstable, H/H 12.0/38.2. Stool guiaic positive in ED. Unclear when \nshe had her last colonoscopy. Deferred GI evaluation given \nresolution of her hematochezia. Her Hgb was at baseline during \nher hospitalization so any bleeding she had prior to admission \nwas no clinically significant. \n \n# Hypokalemia: Resolved. K 3.2 on admission, received potassium \n40 mEq IV in ED. Likely in the setting of diarrhea/GI losses. \n \n#RA: Continued home Plaquenil and prednisone per outpatient \nRheumatologist. Continued APAP, diclofenac for pain.\n \n#HTN. Held home triamterene-HCTZ for now.\n \n#hx of biliary strictures: sees Dr. ___ biliary stricture\nc/b cholangitis . Continued home ursodiol \n \n#GERD: continued omeprazole \n \n#RLS: continued carvidopa-levodopa \n \n#OSA: continued nocturnal BiPAP \n\n# Neuropathic ulcers/wounds. Pt followed as outpatient by \nPodiatry. Per discussion with Podiatry team, will plan to have \npatient be taken to the ___ clinic at ___ \nfollowing discharge for Unna boot placement (has this done\n1x/week) and will provide cab voucher so she can go back to her \nALF from clinic. \n \n \n***TRANSITIONAL ISSUES***\n- Patient to be seen in ___ clinic at ___ \nfollowing discharge for Unna boot placement as described above.\n- Home triamterene-HCTZ held at discharge.'}}
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{'final_diagnoses': ['___ diarrhea', 'Neuropathic ulcer'], 'procedures': ['none'], 'visit_summary': '___ with hx of RA, diverticulosis s/p R hemicolectomy (___), \nchronic R foot plantar ulcer, recent discharge following \nmechanical fall sustaining multiple lacs, presents with 1 day of \nLLQ abdominal pain a/w bloody diarrhea found to have abd CT \nfindings concerning for colitis. \n \n# Abdominal Pain/Diarrhea. Improved. Patient presented with \nLLQ abdominal pain associated with 24 hrs of bloody diarrhea \nprior to admission. CT abdomen showed inflammatory changes of \nthe sigmoid colon and splenic flexure concerning for colitis. \nUpon admission, her diarrhea resolved. Given her improvement of \nsymptoms, antibiotics were initially held. However, stool \nculture returned C. diff positive for which she was placed on PO \nvancomycin. The patient was initially placed on bowel rest, but \nher diet was successfully advanced to a regular diet.\n \n# Hematochezia: Resolved. Patient with hematochezia in the \nsetting of diarrhea. On admission, patient hemodynamically \nstable, H/H 12.0/38.2. Stool guiaic positive in ED. Unclear when \nshe had her last colonoscopy. Deferred GI evaluation given \nresolution of her hematochezia. Her Hgb was at baseline during \nher hospitalization so any bleeding she had prior to admission \nwas no clinically significant. \n \n# Hypokalemia: Resolved. K 3.2 on admission, received potassium \n40 mEq IV in ED. Likely in the setting of diarrhea/GI losses. \n \n#RA: Continued home Plaquenil and prednisone per outpatient \nRheumatologist. Continued APAP, diclofenac for pain.\n \n#HTN. Held home triamterene-HCTZ for now.\n \n#hx of biliary strictures: sees Dr. ___ biliary stricture\nc/b cholangitis . Continued home ursodiol \n \n#GERD: continued omeprazole \n \n#RLS: continued carvidopa-levodopa \n \n#OSA: continued nocturnal BiPAP \n\n# Neuropathic ulcers/wounds. Pt followed as outpatient by \nPodiatry. Per discussion with Podiatry team, will plan to have \npatient be taken to the ___ clinic at ___ \nfollowing discharge for Unna boot placement (has this done\n1x/week) and will provide cab voucher so she can go back to her \nALF from clinic. \n \n \n***TRANSITIONAL ISSUES***\n- Patient to be seen in ___ clinic at ___ \nfollowing discharge for Unna boot placement as described above.\n- Home triamterene-HCTZ held at discharge.', 'medications_prescribed': ['1. Vancomycin Oral Liquid ___ mg PO Q6H \nRX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours \nDisp #*42 Capsule Refills:*0 ', '2. Acetaminophen 500 mg PO 5X/DAY ', '3. Align (Bifidobacterium infantis) 4 mg oral DAILY ', '4. Calcium Citrate + D (calcium citrate-vitamin D3) 630 mg \ncalcium - 200 units other oral DAILY ', '5. Carbidopa-Levodopa (___) 1 TAB PO QHS ', '6. diclofenac sodium 75 mg oral DAILY ', '7. Docusate Sodium 100 mg PO BID ', '8. Fluticasone Propionate NASAL 2 SPRY NU QHS ', '9. GuaiFENesin ___ mL PO QHS:PRN cough ', '10. Hydroxychloroquine Sulfate 200 mg PO BID ', '11. Loratadine 10 mg PO QHS:PRN congesetion ', '12. Omeprazole 40 mg PO DAILY ', '13. PredniSONE 5 mg PO BID ', '14. Psyllium Wafer 1 WAF PO DAILY ', '15. Quin B Strong (B complex-C-folic acid-Zn) 500-400-15 \nmg-mcg-mg oral DAILY ', '16. Sodium Chloride Nasal ___ SPRY NU QHS:PRN congestion ', '17. Ursodiol 300 mg PO TID ', '18. Vitamin D 1000 UNIT PO DAILY ', '19. HELD- Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY This \nmedication was held. Do not restart Triamterene-HCTZ (37.5/25) \nuntil you see your primary care physician']}
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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': 'Found down', 'medical_history': ['None', '1 month ago - car accident but vague headaches here and there.'], 'family_history': 'Unknown', 'present_illness': '___ no known PMH found down ___ AM likely complicated by\naspiration transferred for concern for NCSE and need for cvEEG.\n\nLNK 10PM ___ - Went to bed with no apparently problems. Found\nunresponsive ___ AM in bed with vomit on pillow and mouth with\nagonal breathing. EMS called and found him with RR ___, O2 sat\n70%s, sinus tachy 148. He was reportedly completely unresponsive\nbut could not be intubated due to his jaw being clenched. He was\ngiven Narcan with no response. No incontinence seen on transfer.\n\n\nIn the ___ ED, fever to ___ rectally, HR 116 ST, BP\n91/51, RR 18. He was intubated for mental status GCS 3 -\nunresponsive to verbal commands or painful stim. Intubated with\nSucc and Versed. Tox screen + for cocaine. Workup additionally\nshowed fever to 102, WBC 21-->26, CK 4000, ___ with Cr 2.7 at\nhighest, hypernatremia (unclear how high), AG metabolic acidosis\n(by report), lactic acidosis with 2.4-->1.7, "mild\ntransaminitis", elevated AP, troponin elevation to 0.21. Flu was\nnegative. He was found to have multifocal opacities most notably\nin LUL on CXR with some opacities seen on CT Abdomen which was\nnegative for abdominal process. NCHCT - showed possible BG\nhypotension due to anoxic brain injury.\n\nHe was evaluated by neurology and loaded with Keppra. \nApparently,\ndue to some eye movements, they felt that NCSE could not be \nruled\nout - we cannot access the neurology note. He was treated with\nVancomycin, CTX, Acyclovir by report. Unasyn was ordered but not\nyet given.\n\nLP was performed showing Glu 81, Protein 25, Clear, Tube 1 - RBC\n0, TNC 2; Tube 4 RBC 0, TNC 2; Opening pressure 22cm H2O. \nCulture\npending. Gram stain - no poly, no organisms.\n\nNeuro exam at ___ reportedly showed: \nOn 10 of prop - Unresponsive to noxious. Pupils 3mm and fixed. \nNo\ncorneals. +gag, Upgoing left toe, no response on right. \nOn 5 of prop - EO to loud verbal stim. \n\nBy report, nephrology evaluated the patient and suggested ___ NS\nmaintenance fluids for hypernatremia - repeated sodium Q6H. No\nindication for hemodialysis right now. Possibly ATN causing\nhypernatremia and Cr elevation.', 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Nadolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', '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': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nadolol', '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': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', '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': 'Morphine Sulfate (Concentrated Oral Soln)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'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': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate (Concentrated Oral Soln)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q2H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hyoscyamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', '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 MR1', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate (Concentrated Oral Soln)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID: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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY: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': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '363', 'valuenum': 363.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '16.9', 'valuenum': 16.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.96, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '89', 'valuenum': 89.0, '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': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '18.8', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '178', 'valuenum': 178.0, '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': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<10.'}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mg/dL', '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': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.1', 'valuenum': 20.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '259', 'valuenum': 259.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '553', 'valuenum': 553.0, '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 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133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-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': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 0.89, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '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': 10.2, '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': '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': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, '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': '___', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HEMATOCRIT PERFORMED.'}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 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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': '16.5', 'valuenum': 16.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90125', 'valuenum': 90125.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, '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': '137', 'valuenum': 137.0, '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}], 'exams': 'ADMISSION PHYSICAL EXAM:\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted\nNeck: Supple, No nuchal rigidity\nPulmonary: Lungs CTA bilaterally without R/R/W\nCardiac: RRR, nl. S1S2\nAbdomen: soft, NT/ND\nExtremities: No ___ edema.\nSkin: no rashes or lesions noted.\n\nNeurologic: Limited by language barrier\n- MS- Alert, focusing/following, following simple commands to\nlift extremities etc. ___ speaking which limits exam. \n- CN- PERRL, EOMI full with lateral end gaze nystagmus\nbilaterally, regarding stimuli to right and left - visual fields\nappear full, tongue midline\n- Motor - All extremities antigravity to command but not\ncooperating with much of the testing - likely limited exam with\nlanguage. Was able to get ___ strength in bilateral triceps. \n- Sensory - Can sense noxious in all four extremities. \n- Reflexes - One beat clonus bilaterally. 1+ b/l biceps \nreflexes,\n2+ b/l patellar and achilles reflexes. Toes both downgoing. \n- Coordination- No clear dysmetria on touching my finger. Does\nnot accurately touch nose. \n- Gait - Unable to test. \n\nDISCHARGE PHYSICAL EXAM:\nNonfocal', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '56721', 'desc': 'Peritonitis (acute) generalized'}, {'icd_code': '5601', 'desc': 'Paralytic ileus'}, {'icd_code': '5724', 'desc': 'Hepatorenal syndrome'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '44283', 'desc': 'Aneurysm of splenic artery'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '0414', 'desc': 'Escherichia coli [E. coli] infection in conditions classified elsewhere and of unspecified site'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}], 'summary': "___ 05:50AM BLOOD WBC-6.6 RBC-4.24* Hgb-12.8* Hct-36.9* \nMCV-87 MCH-30.2 MCHC-34.7 RDW-12.0 RDWSD-38.2 Plt ___\n___ 07:39PM BLOOD WBC-26.0* RBC-4.51* Hgb-13.3* Hct-39.8* \nMCV-88 MCH-29.5 MCHC-33.4 RDW-12.7 RDWSD-41.3 Plt ___\n___ 07:39PM BLOOD ___ PTT-27.8 ___\n___ 05:50AM BLOOD Glucose-90 UreaN-7 Creat-0.7 Na-141 K-3.9 \nCl-107 HCO3-21* AnGap-17\n___ 07:39PM BLOOD Glucose-127* UreaN-19 Creat-1.3* Na-142 \nK-3.8 Cl-110* HCO3-18* AnGap-18\n___ 05:00AM BLOOD ALT-115* AST-116* CK(CPK)-5030* \nAlkPhos-65 TotBili-1.2\n___ 07:39PM BLOOD ALT-116* AST-190* LD(LDH)-773* \n___ AlkPhos-84 Amylase-464* TotBili-0.7\n___ 07:39PM BLOOD Lipase-22\n___ 03:16AM BLOOD cTropnT-0.06*\n___ 07:39PM BLOOD CK-MB-78* MB Indx-0.6 cTropnT-0.10*\n___ 05:50AM BLOOD Calcium-8.7 Phos-4.1 Mg-1.8\n___ 07:39PM BLOOD Albumin-3.6 Calcium-7.4* Phos-4.5 Mg-1.7\n___ 07:39PM BLOOD TSH-1.0\n___ 12:20AM BLOOD Vanco-9.1*\n___ 02:55PM BLOOD Vanco-15.4\n___ 03:16AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 11:27AM BLOOD Type-ART pO2-113* pCO2-35 pH-7.39 \ncalTCO2-22 Base XS--2\n___ 11:27AM BLOOD Lactate-1.6\n\n___\n1. Study is mildly degraded by motion. \n2. Bilateral globus pallidus signal abnormality described above. \n Findings are \nnonspecific, with differential considerations including hypoxic \nischemic \nencephalopathy, carbon monoxide or cyanide poisoning, drug \nabuse, and various \nother metabolic conditions. \n3. Left caudate body and lentiform nucleus signal abnormality, \nas described \nabove, may represent an acute to early subacute infarction or \nrelated to \nhypoxic ischemic condition. \n4. No evidence of circle of ___ stenosis, occlusion, or \naneurysm formation. \n5. No evidence of cervical carotid or vertebral artery stenosis, \nocclusion, or \ndissection. \n\n___ Chest w/ contrast\n1. No acute posttraumatic injury to the chest. \n2. Multifocal patchy linear opacities within both lung bases \nand the \nposterior segments of both upper lobes most likely related to \naspiration \npneumonia. Small amount of layering debris in the lower \ntrachea. \n\n___ Shoulder XR\nNo evidence of fracture or dislocation in the left shoulder. \nMultifocal \nopacities and consolidations throughout the lungs were better \nevaluated on \nconcurrent CT. \n\n___\n Normal biventricular cavity sizes with preserved regional and \nlow normal global biventricular systolic function. No valvular \npathology or pathologic flow identified. No definite structural \ncardiac source of embolism identified.\n\n___\nNo spontaneous echo contrast or thrombus is seen in the body of \nthe left atrium/left atrial appendage or the body of the right \natrium/right atrial appendage. No atrial septal defect or patent \nforamen ovale is seen by 2D, color Doppler or saline contrast \nwith maneuvers. Overall left ventricular systolic function is \nnormal (LVEF>55%). with normal free wall contractility. The \naortic valve leaflets (3) appear structurally normal with good \nleaflet excursion. No masses or vegetations are seen on the \naortic valve. No aortic regurgitation is seen. The mitral valve \nleaflets are structurally normal. No mass or vegetation is seen \non the mitral valve. Trivial mitral regurgitation is seen. There \nis no pericardial effusion.\nPt is a ___ w/ no known PMH of drug abuse who was found down \n___ AM with likely aspiration and transferred from OSH (___ \n___) due to concern for NCSE. Hospital course at ___ was \ncomplicated by ___, aspiration PNA, and new GP cocci bacteremia.\n\n#Neuro:\nPt was initially admitted to NeuroICU with improved mental \nstatus compared to OSH reports. He was subsequently extubated \nwith no concern for non-convulsive status epilepticus. He \nunderwent MRI/MRA Brain which showed b/l globus pallidus \nhyperintensities and L acute to subacute subcortical stroke. He \nwas maintained on Keppra and underwent routine EEG which showed \ngeneralized slowing but no epileptiform abnormalities or concern \nfor seizure. \n\n#Cardio:\nFrom OSH reports, pt noted to have mild troponinemia which \ncontinued to trend downward during pt's stay. Pt underwent TTE \nwith no acute abnormalities such as intracardiac vegetations \nsuggestive of endocarditis. Per recommendations of ID, he \nunderwent TEE with no concerning findings as well. \n\n#MSK:\nPt arrived from OSH with elevated CK likely related to rhabdo, \nseen to downtrend daily on IVFs. \n\n#ID: \nInformed that OSH labs showed Group C strep/GPR bacteremia on \n___ bottles. Pt started on Vancomycin and ID was consulted for \nassistance. TTE/TEE performed as above. After further eval, \nconcern that blood cultures were contaminant and patient's \nantibiotics were stopped without following deterioration."}}
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{'final_diagnoses': ['Seizure activity'], 'procedures': ['Intubation', 'TEE'], 'visit_summary': "Pt is a ___ w/ no known PMH of drug abuse who was found down \n___ AM with likely aspiration and transferred from OSH (___ \n___) due to concern for NCSE. Hospital course at ___ was \ncomplicated by ___, aspiration PNA, and new GP cocci bacteremia.\n\n#Neuro:\nPt was initially admitted to NeuroICU with improved mental \nstatus compared to OSH reports. He was subsequently extubated \nwith no concern for non-convulsive status epilepticus. He \nunderwent MRI/MRA Brain which showed b/l globus pallidus \nhyperintensities and L acute to subacute subcortical stroke. He \nwas maintained on Keppra and underwent routine EEG which showed \ngeneralized slowing but no epileptiform abnormalities or concern \nfor seizure. \n\n#Cardio:\nFrom OSH reports, pt noted to have mild troponinemia which \ncontinued to trend downward during pt's stay. Pt underwent TTE \nwith no acute abnormalities such as intracardiac vegetations \nsuggestive of endocarditis. Per recommendations of ID, he \nunderwent TEE with no concerning findings as well. \n\n#MSK:\nPt arrived from OSH with elevated CK likely related to rhabdo, \nseen to downtrend daily on IVFs. \n\n#ID: \nInformed that OSH labs showed Group C strep/GPR bacteremia on \n___ bottles. Pt started on Vancomycin and ID was consulted for \nassistance. TTE/TEE performed as above. After further eval, \nconcern that blood cultures were contaminant and patient's \nantibiotics were stopped without following deterioration.", 'medications_prescribed': ['1. LevETIRAcetam 1000 mg PO BID \nRX *levetiracetam 1,000 mg 1 tablet(s) by mouth Twice daily Disp \n#*60 Tablet Refills:*2']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'fever to 103 at home', 'medical_history': ['Renal Mass', 'Hypertension', 'Hypercholesterolemia.', 'History of urinary incontinence.', 'Psoriasis'], 'family_history': "No known family of malignancy. One brother with grave's disease, \nand a niece (same brother's daughter) with lupus.", 'present_illness': 'The patient is a ___ year old woman with known hypertension, \nhyperlipidemia and recent admission ___ to ___ with \nsevere symptomatic hypercalcemia and possible renal mass \npresents to the ED with fever to 103, chills and generalized \nweakness.\n\nPatient initially presented ___ with subacute onset of \nfatigue and ataxia and found to have ARF, hypercalcemia, \nhypokalemia, anemia and renal mass on imaging which was not \nevaluated with contrast due to the acute renal failure. \nHypercalcemia treated with IVFs and IV pamidronate and once \ncorrected fatigue/ataxia resolved. Etiology for hypercalcemia \nwas thought to be neoplastic (RCC due to increased PTHrP however \nwas wnl) vs milk alkali syndrome (takes 4 tums per day), but was \nnot fully elucidated at the time of discharge. SPEP/UPEP were \nnegative but B2-microglobulin was elevated, and overal \ngammaglobulin levels were lower than expected. \n\nAt discharge patient had low calcium and phosphate thought to be \nsecondary to bisphosphonate therapy. ARF thought to be due to \nhypercalcemia induced dehydration, improved from 3.5 to 1.5 with \nIVFs. Regarding the renal mass, CT of abdomen showed an \nirregular left kidney with multiple lesions and indeterminate \nhyperdense right renal lesion. MRI w/o contrast was \ninconclusive, and an MR with contrast was planned. Patient had \na head CT, CXR, C-spine film and pelvic MRI which were all \nnegative for metastatic disease. No contrast imaging obtained \ngiven ARF and plan is for MRI with gad as outpatient once renal \nfunction stabalizes to eGFR>30 x 2 weeks. Plans made for follow \nup with urology after discharge for further evaluation of renal \nmass. Of note, patient had an EGD/colonoscopy for work-up of \nnew anemia, rectal mass and episodes of blood on toilet paper \nwhich did not identify an obvious source - biopsy of rectal mass \nwas negative for malignancy. Iron studies were consistent with \nanemia of chronic disease. At discharge on ___ labs \nsignificant for hct 24, cr 1.6 and calcium of 7.6. \n\nPatient reports she continued to have fatigue since hospital \ndischarge however was able to go for walks outside. This \nevening developed fever to 103.4 and chills. Denies any cough, \nsob, URI symptoms, dysuria, n/v/d or abdominal pain. No neck \nstiffness, visual changes or HA (slight HA with fever now \nresolved). No coughing with swallowing. First BM today after 1 \nweek, took laxatives, loose stool. No travel or sick contacts. \nNo rashes. Decreased appetite today. \n\nIn ED: 102.4 90P 166/55 18 98%RA; tylenol ___ x 1, \nvancomycin 1gm iv x 1, levaquin 750mg iv x 1, flagyl 500mg iv, \n1L NS\n\nROS: \n- General: + fevers, + chills, + sweats, - weight loss\n- HEENT: no changes in vision or hearing, no rhinorrhea, nasal \ncongestion, headaches, sore throat\n- Lungs: no cough, shortness of breath, dyspnea on exertion\n- Cardiac: no chest pain, pressure, palpitations, orthopnea, PND\n- GI: no abdominal pain, nausea, vomiting, diarrhea, \nconstipation, BRBPR, melena\n- GU: no dysuria, hematuria, urgency, frequncey\n- MSK: no arthralgias or myalgias\n- Neuro: no weakness, numbness, seizures, difficulty speaking, \nchanges in memory. \n- Skin: no rash or pruritis\n- Psychiatry: no depression or suicidal ideation', 'medications': [{'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', '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': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', '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 Glycerophosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', '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': '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': 'Sodium Glycerophosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': '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', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85.8', 'valuenum': 85.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, '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': '169', 'valuenum': 169.0, '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': '85', 'valuenum': 85.0, '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': '117', 'valuenum': 117.0, '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': '___', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', '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': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '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': '10-40', 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, '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': '11', 'valuenum': 11.0, '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': '22', 'valuenum': 22.0, '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': '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': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '2.2', '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': '142', 'valuenum': 142.0, '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': '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': '35.8', 'valuenum': 35.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '11.4', 'valuenum': 11.4, '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': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', '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': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '78', 'valuenum': 78.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', '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': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.043', 'valuenum': 1.043, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': 'AMBER', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ABN COLOR MAY AFFECT DIPSTICK.'}, {'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': 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': '110', 'valuenum': 110.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, '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': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.62', 'valuenum': 3.62, '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}], 'exams': 'Admission examination\nVS: Tc 98.7F Tmax ___ 136/72 83P 18 97%RA\nGen: alert, NAD, pleasant, resting comfortably in bed\nHeent: anicteric, eomi, perrl, op clear s lesions, mmd\nNeck: supple, no LAD, no JVD\nCv: +s1, s2 -m/r/g\nPulm: decreased BS at left base\nAbd: soft, nt, nd, +bs\nExtr: no edema, 2+ dp/pt\nNeuro: cn ___ grossly intact, no focal deficits\nSkin: no rashes', 'diagnoses': [{'icd_code': '03840', 'desc': 'Septicemia due to gram-negative organism, unspecified'}, {'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '57451', 'desc': 'Calculus of bile duct without mention of cholecystitis, with obstruction'}, {'icd_code': 'V8541', 'desc': 'Body Mass Index 40.0-44.9, adult'}, {'icd_code': '99591', 'desc': 'Sepsis'}, {'icd_code': '7866', 'desc': 'Swelling, mass, or lump in chest'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}], 'summary': ".\n___ MRI Abdomen W/O Contrast:\n1. Evaluation of the kidneys is extremely limited due in part to \nthe very \nabnormal signal intensity from both kidneys, and also due to \nlack of \nintravenous contrast. Multiple bilateral T1 hyperintense lesions \nare likely hemorrhagic cysts however recommend reimaging when \nthe patient's acute renal impairment improves to exclude the \npossibility of enhancing mass. \n2. Trace of free fluid with more localized edema around the \ndescending colon and sigmoid may reflect resolving \ndiverticulitis. Clinical correlation recommended. \n3. Diffuse urothelial thickening in the left renal pelvis and \nureter of \nuncertain significance, though possibly related to the \ninflammatory process in the left lower quadrant. \n4. Tiny bilateral pleural effusions. \n5. Hepatic steatosis. \n.\n___ CT A/P W/O Contrast:\n1. No acute intra-abdominal process without evidence of \nobstruction. \n2. Assessment for rectal lesion is limited in the absence of \nintravenous \ncontrast though slight anorectal wall thickening is noted and \ncorrelation with examination/direct visualization could be \nperformed. \n3. Irregular left kidney with multiple lesions and indeterminate \nhyperdense right renal lesion. Recent ultrasound noted a \nvascular lesion which is not discretely demonstrated in the \nabsence of intravenous contrast and contrast MR can be obtained \nonce acute renal failure resolves for better evaluation. \n.\n___ Renal Ultrasound:\n1. Hypoechoic lesions in both kidneys likely representing \ncomplex cysts. \n2. Solid vascular lesion in the left kidney concerning for renal \nneoplasm. \nFurther evaluation with MRI is recommended. \n.\n___ EGD:\nGrade 1 esophagitis in the gastroesophageal junction compatible \nwith mild esophagitis. Abnormal mucosa in the stomach body and \nfundus compatible with mild gastritis. Otherwise normal EGD to \nthird part of the duodenum\n.\n___ Colonoscopy:\nGranularity, friability and erythema in the rectum compatible \nwith mild proctitis (biopsy: superficial erosion, non-specific \nfinding. No features of an inflammatory colitis are seen). \nDiverticulosis of the sigmoid colon. Otherwise normal \ncolonoscopy to cecum.\n.\n___ CXR: IMPRESSION: No acute intrathoracic process. \n.\n___ CXR:-FINDINGS: In comparison with the study of ___, there is \ncontinued enlargement\nof the cardiac silhouette with indistinctness of pulmonary \nvessels consistent\nwith elevated pulmonary venous pressure. Retrocardiac \nopacification with\nsilhouetting of a portion of the hemidiaphragm most likely \nreflects\natelectasis. However, in the appropriate clinical setting, \nsupervening\npneumonia will have to be considered\n.\nChest ct ___:\n1. Atelectasis at the left base, in similar configuration to \nprior abdominal\nCT. No evidence of pneumonia.\n2. mild pulmonary edema.\n3. Multiple focal nodules measuring up to 4 mm. Unclear to what \nextent thesemay be related to edema. In a low-risk patient, no \nfurther followup is\nneeded. In a high-risk patient, followup CT at 12 months is \nrecommended.\n4. Renal lesions seen within the left upper pole, incompletely \nevaluated on\nthis examination and better seen on the recent MRI.\n5. Left adrenal nodule, indeterminate on this examination\n.\n___ ECG: 97 NSR, nl axis, nl intervals, no ST-T changes\n.\n___ ECHO:-The left atrium is mildly dilated. The estimated \nright atrial pressure is at least 15 mmHg. Left ventricular wall \nthicknesses are normal. The left ventricular cavity size is \nnormal. Due to suboptimal technical quality, a focal wall motion \nabnormality cannot be fully excluded. Overall left ventricular \nsystolic function is low normal (LVEF 50%). The inferior and \nposterior walls appear hypokinetic in some views. The right \nventricular free wall thickness is normal. The right ventricular \ncavity is dilated with depressed free wall contractility. The \naortic valve leaflets (3) are mildly thickened but aortic \nstenosis is not present. No aortic regurgitation is seen. The \nmitral valve leaflets are mildly thickened. The mitral valve \nleaflets are myxomatous. There is mild bileaflet mitral valve \nprolapse (posterior leaflet > anterior leaflet). A late systolic \njet of mild (1+) mitral regurgitation is seen. The tricuspid \nvalve leaflets are mildly thickened. Moderate [2+] tricuspid \nregurgitation is seen. There is moderate pulmonary artery \nsystolic hypertension. There is no pericardial effusion.\nCompared with the findings of the prior study (images reviewed) \nof ___, the inferior and posterior walls of the left \nventricle, as well as the right ventricle, now appear \nhypokinetic\nIf clinically indicated, a transesophageal echocardiographic \nexamination is recommended for exclusion of vegetations.\nIMPRESSION: no definite vegetations seen, but this study is \nsuboptimal\n.\nMRI abdomen -MPRESSION:\n1. Hepatic steatosis.\n2. Edematous gallbladder wall however the gallbladder is \nnon-distended and\nthere is no evidence of cholelithiasis. This is likely related \nto third\nspacing of fluids.\n3. Bilateral mixture of hemorrhagic / proteinaceous and simple \ncystic lesionsthroughout both kidneys as described. No solid \nrenal mass identified in theleft kidney. \n4. Indeterminate hypo-enhancing 5mm lesion in the upper pole of \nthe right\nkidney. Interval follow-up in 6 months recommended. Findings may \nsimply\nrepresent partial voluming of a hemorrhagic / proteinaceous cyst \nhowever a\nsmall papillary RCC cannot be entirely excluded. This is not \nthought to be\nrelated to the patients symptom complex.\n5. Colonic diverticulosis.\n.\n___ flow cytometry-\n\nFLOW CYTOMETRY REPORT\nRESULTS:\nImmunophenotype markers analyzed: CD45, CD2, CD7, CD5, CD19, \nCD10, ___, CD3, CD20, CD23, FMC7, Kappa, Lambda.\nThree color gating is performed (light scatter vs. CD45) to \noptimize lymphocyte yield.\nB cells comprise 13% of lymphoid-gated events, are polyclonal, \nand do not express aberrant antigens. \nT cells comprise 67% of lymphoid gated events, express mature \nlineage antigens.\n \nINTERPRETATION\n \nNon-specific T cell dominant lymphoid profile; diagnostic \nimmunophenotypic features of involvement by leukemia/lymphoma \nare not seen in specimen. Correlation with clinical findings \nand morphology (see ___ is recommended. Flow cytometry \nimmunophenotyping may not detect all lymphomas due to \ntopography, sampling or artifacts of sample preparation. \nNote: This test was performed using analyte specific reagents \n(ASRs). These ASRs have not been cleared or approved by the ___ \nFood and Drug Administration (FDA). However, the FDA has \ndetermined that such clearance or approval is not necessary . \nThis test was developed and its performance characteristics \ndetermined by the Flow Cytometry Laboratory at ___ \n___, which is licensed by ___ to perform \nhigh complexity tests. This test was used for clinical \npurposes; it should not be regarded as for research.\n.\n___ CXR-IMPRESSION: Increased mild pulmonary edema. Increased \nleft basilar\natelectasis.\n.\nMicrobiology-\n___ CULTUREBlood Culture, \nRoutine-PENDINGINPATIENT\n___ CULTUREBlood Culture, \nRoutine-PENDINGINPATIENT\n___ CULTURE-FINALINPATIENT\n___ MARROWFLUID CULTURE-PRELIMINARY; \nFUNGAL CULTURE-PRELIMINARY; ACID FAST \nCULTURE-PRELIMINARYINPATIENT\n___ (CMV)CMV Viral \nLoad-FINALINPATIENT\n___ CULTURE-FINAL {YEAST}INPATIENT\n___ CULTUREBlood Culture, \nRoutine-PENDINGINPATIENT\n___ (CMV AB)CMV IgG ANTIBODY-FINAL; CMV \nIgM ANTIBODY-FINALINPATIENT\n___ PLASMA REAGIN \nTEST-FINALINPATIENT\n___ CULTURE ( MYCO/F LYTIC BOTTLE) NOT \nPROCESSED IN PATIENT\n___ SEROLOGY-FINALINPATIENT\n___ CULTUREBlood Culture, \nRoutine-FINALINPATIENT\n___ CULTUREBlood Culture, \nRoutine-FINALINPATIENT\n___ CULTUREBlood Culture, \nRoutine-FINALINPATIENT\n___ CULTUREBlood Culture, \nRoutine-FINALINPATIENT\n___ DIFFICILE TOXIN A & B \nTEST-FINALINPATIENT\n___ CULTURE-FINALINPATIENT\n___ CULTUREBlood Culture, \nRoutine-FINALEMERGENCY WARD\n___ CULTUREBlood Culture, \nRoutine-FINALEMERGENCY WARD\n.\n\n.\n\n___ 06:20AM BLOOD WBC-11.1* RBC-2.82* Hgb-8.9* Hct-26.5* \nMCV-94 MCH-31.6 MCHC-33.6 RDW-16.0* Plt ___\n___ 06:25AM BLOOD WBC-10.0 RBC-2.77* Hgb-8.6* Hct-25.3* \nMCV-92 MCH-31.2 MCHC-34.1 RDW-15.6* Plt ___\n___ 06:05AM BLOOD WBC-8.0 RBC-2.65* Hgb-8.5* Hct-24.9* \nMCV-94 MCH-31.9 MCHC-34.1 RDW-16.2* Plt ___\n___ 08:40AM BLOOD WBC-7.7 RBC-2.89* Hgb-9.1* Hct-27.1* \nMCV-94 MCH-31.5 MCHC-33.6 RDW-15.8* Plt ___\n___ 07:55AM BLOOD WBC-7.7 RBC-2.80* Hgb-9.2* Hct-25.5* \nMCV-91 MCH-32.8* MCHC-36.0* RDW-16.2* Plt ___\n___ 05:53AM BLOOD WBC-7.0 RBC-2.86* Hgb-9.0* Hct-26.2* \nMCV-92 MCH-31.7 MCHC-34.6 RDW-15.9* Plt ___\n___ 07:40AM BLOOD WBC-6.5 RBC-2.89* Hgb-9.1* Hct-26.2* \nMCV-91 MCH-31.5 MCHC-34.8 RDW-15.9* Plt ___\n___ 01:30AM BLOOD WBC-4.9 RBC-2.89*# Hgb-9.1* Hct-26.0* \nMCV-90 MCH-31.5 MCHC-35.1* RDW-15.6* Plt ___\n___ 05:25AM BLOOD WBC-5.4 RBC-2.29* Hgb-7.7* Hct-21.8* \nMCV-95 MCH-33.5* MCHC-35.2* RDW-14.6 Plt ___\n___ 03:37AM BLOOD WBC-6.5 RBC-2.50* Hgb-8.2* Hct-23.5* \nMCV-94 MCH-32.9* MCHC-35.0 RDW-14.4 Plt ___\n___ 10:45PM BLOOD WBC-7.9 RBC-2.89* Hgb-9.5* Hct-27.5* \nMCV-95 MCH-33.1* MCHC-34.7 RDW-14.4 Plt ___\n___ 03:20PM BLOOD Neuts-80.4* Lymphs-14.2* Monos-3.5 \nEos-1.7 Baso-0.2\n___ 10:45PM BLOOD Neuts-89.0* Lymphs-7.6* Monos-2.0 Eos-1.3 \nBaso-0.2\n___ 01:30AM BLOOD ___\n___ 05:30AM BLOOD ___ PTT-37.0* ___\n___ 05:25AM BLOOD ___\n___ 06:25AM BLOOD Parst S-NEGATIVE\n___ 06:05AM BLOOD Parst S-NEGATIVE\n___ 07:55AM BLOOD ESR-87*\n___ 05:15PM BLOOD Ret Aut-2.6\n___ 06:20AM BLOOD Glucose-130* UreaN-14 Creat-1.1 Na-137 \nK-4.1 Cl-104 HCO3-24 AnGap-13\n___ 06:05AM BLOOD Glucose-117* UreaN-15 Creat-1.0 Na-135 \nK-3.9 Cl-103 HCO3-23 AnGap-13\n___ 08:40AM BLOOD Glucose-136* UreaN-15 Creat-1.0 Na-137 \nK-3.8 Cl-105 HCO3-23 AnGap-13\n___ 07:55AM BLOOD Glucose-132* UreaN-16 Creat-1.0 Na-137 \nK-3.6 Cl-107 HCO3-22 AnGap-12\n___ 03:20PM BLOOD Glucose-124* UreaN-20 Creat-1.2* Na-139 \nK-4.1 Cl-104 HCO3-23 AnGap-16\n___ 01:30AM BLOOD UreaN-17 Creat-1.3* Na-139 K-3.0* Cl-105\n___ 05:25AM BLOOD Glucose-131* UreaN-17 Creat-1.3* Na-137 \nK-3.7 Cl-103 HCO3-20* AnGap-18\n___ 05:15PM BLOOD Glucose-116* UreaN-19 Creat-1.3* Na-138 \nK-3.9 Cl-104 HCO3-21* AnGap-17\n___ 10:45PM BLOOD Glucose-124* UreaN-17 Creat-2.1* Na-136 \nK-4.0 Cl-99 HCO3-22 AnGap-19\n___ 06:20AM BLOOD ALT-85* AST-33 AlkPhos-226* TotBili-0.7\n___ 06:25AM BLOOD ALT-106* AST-32 LD(___)-229 AlkPhos-241* \nTotBili-0.9\n___ 06:05AM BLOOD ALT-143* AST-47* AlkPhos-246* TotBili-0.9\n___ 08:40AM BLOOD ALT-152* AST-52* AlkPhos-232* TotBili-1.0\n___ 07:55AM BLOOD CK(CPK)-37\n___ 05:53AM BLOOD ALT-148* AST-64* LD(LDH)-318* \nAlkPhos-177*\n___ 07:40AM BLOOD ALT-156* AST-60*\n___ 03:20PM BLOOD ALT-192* AST-99* LD(___)-438* CK(CPK)-157 \nAlkPhos-157* TotBili-1.2\n___ 10:45PM BLOOD ALT-47* AST-34 AlkPhos-82 Amylase-102* \nTotBili-0.4\n___ 03:37AM BLOOD CK(CPK)-229*\n___ 05:25AM BLOOD Lipase-25\n___ 05:15PM BLOOD Lipase-25\n___ 10:45PM BLOOD Lipase-81*\n___ 05:15PM BLOOD CK-MB-3 cTropnT-0.04*\n___ 09:45AM BLOOD cTropnT-0.07*\n___ 03:37AM BLOOD CK-MB-2 cTropnT-0.06*\n___ 07:55AM BLOOD TotProt-4.7* Calcium-7.4* Phos-1.6* \nMg-2.0\n___ 10:45PM BLOOD Albumin-4.2 Calcium-9.0 Phos-2.8 Mg-1.5*\n___ 05:25AM BLOOD VitB12-652 Folate-GREATER TH Hapto-275*\n___ 05:15PM BLOOD TSH-1.3\n___ 01:30AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE IgM \nHAV-NEGATIVE\n___ 07:55AM BLOOD Smooth-NEGATIVE\n___ 05:53AM BLOOD ___\n___ 07:55AM BLOOD PEP-HYPOGAMMAG IgG-277* IgA-71 IgM-119\n___ 05:53AM BLOOD HIV Ab-NEGATIVE\n___ 05:53AM BLOOD Vanco-18.0\n___ 07:55AM BLOOD HCV Ab-NEGATIVE\n___ 05:43AM BLOOD freeCa-0.95*\n___ 05:53AM BLOOD ANAPLASMA PHAGOCYTOPHILUM AND EHRLICHIA \nCHAFFEENSIS ANTIBODY PANEL (IGM AND IGG) -Test \n___ 07:55AM BLOOD EBV PCR, QUANTITATIVE, WHOLE BLOOD-PND\n___ yo F with hypertension, hyperlipidemia and recent admission \n___ to ___ with hypercalcemia and possible renal mass \nawaiting further work-up presented to the ED with fever to 103, \nchills, and generalized weakness and found to have acute on \nchronic renal failure. No clear source of fever was initially \nidentified. \n\n#Fever: There was initial concern for a LLL opacity on chest \nxray, however it was subtle. A chest CT was done, which did not \nreveal parenchymal disease or infection. Blood and urine \ncutlures were checked and were negative. A mycoltyic blood \nculture, to evaluate for fungi and mycobacteria was also sent, \nwhich was negative. C. Diff was checked, which was unrevealing. \nShe was initially emprically treated with vancomycin and zosyn \nfor possible hospital acquired pneumonia, which was then changed \nto Vancomycin and Cefepime, and then transitioned to vancomycin \nand levofloxacin. She completed 5 days of broad spectrum \nantibiotics with continued nightly peak temperatures of \n___. As a result, the antibiotics were discontinued and \nthe patient was observed off this therapy and her fever curve \noverall trended down, but continued. Work-up for lyme and \nehrlichia was negative. Concerned increased for an infection \nthat might involve marrow suppression, and an infectious disease \nconsultation was obtained to assist with that work-up. \nHistoplasma antigen was sent and PENDING at the time of \ndischarge. Bone marrow was sent for coccidiomycosis, \nhistoplasma, and blastomycosis. Results are PENDING at time of \ndischarge. In addition, CMV, EBV did not reveal acute infection, \nblood smears were negative for parasitic infection. HIV was \nnegative. Hepatitis serologies were negative as well as \nSPEP/UPEP. An ___ was sent to evaluate for drug-induced lupus \nor other rheumatologic conditions, which was negative along with \nanti-SM ab. ESR was elevated. However, pt never had any \nlocalizing infectious symptoms such as headache, neck stiffness, \ncough, abdominal pain/n/v, dysuria, myalgias or arthralgias. TTE \nwas negative for endocarditis and cultures were unrevealing. \nOncology was consulted along with ID. Pt underwent a bone marrow \nbiopsy on ___ and marrow was sent for flow, which appears to be \nnegative for leukemic process. Marrow cultures are still \npending. PPD was negative. Drug fever is a possibility, however \nthere is no particular temporal relationship nor are there any \nnew medications this admission. Pt did receive pamidronate last \nadmission and this can cause fever, but unlikely to be delayed \nin presentation. Cause of fever still remains unclear at time of \ndischarge. However, pt had a tmax of 99 on day of discharge and \nrequested discharge. She will continue to follow up with her \nPCP, ID after discharge for continued evaluation. Can consider \nrheumatologic disorder, but ___ is negative. Pt did not have any \nother symptoms to suggest Adult's Stills or Familial \nMediterranean Fever. If workup still remains negative, could \nconsider sending ANCA to evaluation for vasculitis. Pt did not \nhave headache or muscle pain to suggest GCA or PMR. \n.\n#hypogammuloglobulinemia-found on SPEP. Likely acquired. Pt \ninitially on empiric antibiotic therapy to cover for possible \ninfection. Can be further monitored in the outpatient setting.\n\n#Acute on chronic renal insufficiency: likely prerenal in the \nsetting of hypovolemia from poor po intake and insensible losses \nfrom fever - last admission had ___ attributed to hypercalcemia \nwhich resolved with IVFs - SPEP/UPEP negative except for \nB2-microglobulin. Cr returned to normal during admission. \n\n#Renal mass: found during last admission. Pt has had several CTs \nand MRIs. Pt has multiple hemorrhagic/proteinaceous renal cysts. \nThere is one cyst in the R.kidney that could be a cyst as above \nor small papillary RCC. This was discussed with the patient. ___ \nwill f/u with Dr. ___ discharge to determine plan of \ncare. Radiology recommended 6month imaging follow up. This may \neventually explain pt's fever if all else is ruled out.\n\n#Hypercalcemia: resolved, thought ___ malignancy vs milk-alkali \nsyndrome, HCTZ use last admission. Her calcium remained stable \nduring this admission, and actually required repletion later in \nthe course, which we suspect is related to the recent \npamidronate therapy. She was advised to follow up in \n___ clinic to determine etiology for recent \nhypercalcemia. Her PTH was normal in the setting of \nhypercalcemia and should be decreased in that setting. This may \nbe suggestive of hyperparathyroidism. She could have thyroid u/s \nand/or sestimibi scan as an outpatient. Hypercalcemia was not an \nissue this admission. Endocrinology follow up was arranged prior \nto discharge. \n\n#Anemia: recent egd/colonoscopy negative for evidence of \nbleeding, rectal mass negative for malignancy; iron studies \nconsistent with anemia of chronic disease. Her hematocrit nadir \nwas 21, for which the patient was transfused. Following this, \nthe Hct remained stable and was 26.5 on day of discharge. Her \naspirin was held during admission. \n\n#Transaminitis: On her prior admission, her LFTs were noted to \nbe normal. On this admission, she was noted to have significant \nelevation of these tests, concerning for either a reaction to a \ntreatment received during the prior admission, or related to the \nunderlying condition. Medication reaction is possible, given her \nrecent prolonged admission, and the intiation of several new \nmedications including hydralazine, as well as pamidronate. Her \nstatin was discontinued on the last admission. Hepatitis \nserologies negative, HIV negative. MRI did not find structural \nabnormality. CMV negative. ___ and anti-SM ab negative.\n\n#HTN: She was continued on her verapamil and hydralazine. ___ \nwas checked to evaluate for possible drug induced lupus caused \nby the hydralazine, which was started during the last admission, \nhowever ___ was negative.\n\n#Constipation: This had resolved at the time of admission with \nlaxatives at home. She was given colace and senna prn.\n\n#HLD: Her statin was held last admission due to muscle spasms, \nit was not restarted this admission. Further management, \nincluding of hypertriglyceridemia is defered to her primary care \nprovider. \n.\n#sun-damaged skin-advised to have regular skin checks with \ndermatology. Pt states she goes every 3 months.\n.\n#psoriasis-not active this admission.\n\nFULL CODE\nHusband:\n___ (h)\n___ (C)"}}
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{'final_diagnoses': ['Fever', 'Anemia', 'Liver function test abnormalities', 'renal cysts, with 1 abnormal appearing cyst', 'recent hypercalcemia', 'hypertension, benign'], 'procedures': ['None'], 'visit_summary': "___ yo F with hypertension, hyperlipidemia and recent admission \n___ to ___ with hypercalcemia and possible renal mass \nawaiting further work-up presented to the ED with fever to 103, \nchills, and generalized weakness and found to have acute on \nchronic renal failure. No clear source of fever was initially \nidentified. \n\n#Fever: There was initial concern for a LLL opacity on chest \nxray, however it was subtle. A chest CT was done, which did not \nreveal parenchymal disease or infection. Blood and urine \ncutlures were checked and were negative. A mycoltyic blood \nculture, to evaluate for fungi and mycobacteria was also sent, \nwhich was negative. C. Diff was checked, which was unrevealing. \nShe was initially emprically treated with vancomycin and zosyn \nfor possible hospital acquired pneumonia, which was then changed \nto Vancomycin and Cefepime, and then transitioned to vancomycin \nand levofloxacin. She completed 5 days of broad spectrum \nantibiotics with continued nightly peak temperatures of \n___. As a result, the antibiotics were discontinued and \nthe patient was observed off this therapy and her fever curve \noverall trended down, but continued. Work-up for lyme and \nehrlichia was negative. Concerned increased for an infection \nthat might involve marrow suppression, and an infectious disease \nconsultation was obtained to assist with that work-up. \nHistoplasma antigen was sent and PENDING at the time of \ndischarge. Bone marrow was sent for coccidiomycosis, \nhistoplasma, and blastomycosis. Results are PENDING at time of \ndischarge. In addition, CMV, EBV did not reveal acute infection, \nblood smears were negative for parasitic infection. HIV was \nnegative. Hepatitis serologies were negative as well as \nSPEP/UPEP. An ___ was sent to evaluate for drug-induced lupus \nor other rheumatologic conditions, which was negative along with \nanti-SM ab. ESR was elevated. However, pt never had any \nlocalizing infectious symptoms such as headache, neck stiffness, \ncough, abdominal pain/n/v, dysuria, myalgias or arthralgias. TTE \nwas negative for endocarditis and cultures were unrevealing. \nOncology was consulted along with ID. Pt underwent a bone marrow \nbiopsy on ___ and marrow was sent for flow, which appears to be \nnegative for leukemic process. Marrow cultures are still \npending. PPD was negative. Drug fever is a possibility, however \nthere is no particular temporal relationship nor are there any \nnew medications this admission. Pt did receive pamidronate last \nadmission and this can cause fever, but unlikely to be delayed \nin presentation. Cause of fever still remains unclear at time of \ndischarge. However, pt had a tmax of 99 on day of discharge and \nrequested discharge. She will continue to follow up with her \nPCP, ID after discharge for continued evaluation. Can consider \nrheumatologic disorder, but ___ is negative. Pt did not have any \nother symptoms to suggest Adult's Stills or Familial \nMediterranean Fever. If workup still remains negative, could \nconsider sending ANCA to evaluation for vasculitis. Pt did not \nhave headache or muscle pain to suggest GCA or PMR. \n.\n#hypogammuloglobulinemia-found on SPEP. Likely acquired. Pt \ninitially on empiric antibiotic therapy to cover for possible \ninfection. Can be further monitored in the outpatient setting.\n\n#Acute on chronic renal insufficiency: likely prerenal in the \nsetting of hypovolemia from poor po intake and insensible losses \nfrom fever - last admission had ___ attributed to hypercalcemia \nwhich resolved with IVFs - SPEP/UPEP negative except for \nB2-microglobulin. Cr returned to normal during admission. \n\n#Renal mass: found during last admission. Pt has had several CTs \nand MRIs. Pt has multiple hemorrhagic/proteinaceous renal cysts. \nThere is one cyst in the R.kidney that could be a cyst as above \nor small papillary RCC. This was discussed with the patient. ___ \nwill f/u with Dr. ___ discharge to determine plan of \ncare. Radiology recommended 6month imaging follow up. This may \neventually explain pt's fever if all else is ruled out.\n\n#Hypercalcemia: resolved, thought ___ malignancy vs milk-alkali \nsyndrome, HCTZ use last admission. Her calcium remained stable \nduring this admission, and actually required repletion later in \nthe course, which we suspect is related to the recent \npamidronate therapy. She was advised to follow up in \n___ clinic to determine etiology for recent \nhypercalcemia. Her PTH was normal in the setting of \nhypercalcemia and should be decreased in that setting. This may \nbe suggestive of hyperparathyroidism. She could have thyroid u/s \nand/or sestimibi scan as an outpatient. Hypercalcemia was not an \nissue this admission. Endocrinology follow up was arranged prior \nto discharge. \n\n#Anemia: recent egd/colonoscopy negative for evidence of \nbleeding, rectal mass negative for malignancy; iron studies \nconsistent with anemia of chronic disease. Her hematocrit nadir \nwas 21, for which the patient was transfused. Following this, \nthe Hct remained stable and was 26.5 on day of discharge. Her \naspirin was held during admission. \n\n#Transaminitis: On her prior admission, her LFTs were noted to \nbe normal. On this admission, she was noted to have significant \nelevation of these tests, concerning for either a reaction to a \ntreatment received during the prior admission, or related to the \nunderlying condition. Medication reaction is possible, given her \nrecent prolonged admission, and the intiation of several new \nmedications including hydralazine, as well as pamidronate. Her \nstatin was discontinued on the last admission. Hepatitis \nserologies negative, HIV negative. MRI did not find structural \nabnormality. CMV negative. ___ and anti-SM ab negative.\n\n#HTN: She was continued on her verapamil and hydralazine. ___ \nwas checked to evaluate for possible drug induced lupus caused \nby the hydralazine, which was started during the last admission, \nhowever ___ was negative.\n\n#Constipation: This had resolved at the time of admission with \nlaxatives at home. She was given colace and senna prn.\n\n#HLD: Her statin was held last admission due to muscle spasms, \nit was not restarted this admission. Further management, \nincluding of hypertriglyceridemia is defered to her primary care \nprovider. \n.\n#sun-damaged skin-advised to have regular skin checks with \ndermatology. Pt states she goes every 3 months.\n.\n#psoriasis-not active this admission.\n\nFULL CODE\nHusband:\n___ (h)\n___ (C)", 'medications_prescribed': ['verapamil 120 mg Tablet Extended Release Sig: One (1) Tablet \nExtended Release PO Q24H (every 24 hours).', 'hydralazine 50 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours).', 'ascorbic acid ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'bisacodyl 5 mg Tablet Sig: One (1) Tablet PO once a day as \nneeded for constipation.', 'omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', 'aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO once a day.', 'calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable \nSig: One (1) Tablet, Chewable 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': 47, 'gender': 'M', 'symptoms': 'Back Pain', 'medical_history': ['DM2', 'HTN', 'hyperlipidemia', 'CRI', 'hearing loss', 'Colonic Polyp', 'Aortic valve replacement s/p endocarditis (MRSA) in ___'], 'family_history': 'No hx of MI or CAD. Mom with DM.', 'present_illness': 'This is a ___ year old male with a history of diabetes type II, \nendocarditis s/p St Judes valve replacement, CRI who presents to \nthe ED with back pain for three weeks. The pain is a crampy pain \nthat occurs in his right gluteus area. It is a sharp pain. Over \nthe past few weeks he has been working with his PCP to control \nthe pain. On ___ the patients exam was notable for new spinal \ntenderness and some new warmth over his skin. PCP attempted to \nobtain MRI of spine at that time but this was recorded as an \nincomplete study. Patient had persistent pain and was reffered \nto the ED. \n\nIn the ED, initial vs were: 98.2 94 119/60 20 100. A CT revealed \na bleed in the psoas muscle on the right. Patient was given was \ngiven vitamin K 10mg, haldol 5mg, dilaudid, ativan. Surgery \nevaluated the patient and said there was no indication for \nsurgery at this time and recommended ___ if continued bleeding. A \nfemoral line was placed for access. Patient was started on one \nunit of FFP. His vitals at the time of transfer 98.1, 139, \n132/59, 18, 100% RA.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'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': 'HYDROmorphone (Dilaudid)', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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}, {'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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H: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': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued 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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'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': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H: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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'NEG', 'valuenum': None, 'valueuom': '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': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 79.2, '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '448', 'valuenum': 448.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71.2', 'valuenum': 71.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '591', 'valuenum': 591.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '31.3', 'valuenum': 31.3, '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': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, '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': '622', 'valuenum': 622.0, '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': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.8', 'valuenum': 4.8, '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '629', 'valuenum': 629.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 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{'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': '35.2', 'valuenum': 35.2, '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': '497', 'valuenum': 497.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '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': '8.5', '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '535', 'valuenum': 535.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, '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': 0.5, '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, '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': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '4.6', 'valuenum': 4.6, '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': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '539', 'valuenum': 539.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 175.0, 'valueuom': 'mg/dL', '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '588', 'valuenum': 588.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, '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': '23.8', 'valuenum': 23.8, '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': '28.8', 'valuenum': 28.8, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '456', 'valuenum': 456.0, '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': '2.97', 'valuenum': 2.97, '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': '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.9', 'valuenum': 3.9, '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': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '106', 'valuenum': 106.0, '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': '11', 'valuenum': 11.0, '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': '___', 'valuenum': 97.6, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '157', 'valuenum': 157.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '609', 'valuenum': 609.0, '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': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, '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}], 'exams': "Physical Exam: \nVitals: T:98.6 BP:120/54 (110's-160's/40's-___) P:90 (80-90's) \nR: 18 O2: 97% RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, good dentition, \nno oralpharyngeal ulcer \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Midline surgical scar along sternum, Regular rate and \nrhythm, normal S1/S2, w/ holosystolic murmur heard best at the \nupper left sternal border, rubs, gallops, valve click heard \nAbdomen: large midline vertical surgical scar extending from \nxyphoid processsoft, non-tender, non-distended, bowel sounds \npresent, no rebound tenderness or guarding, no organomegaly \nGU: foley in place \nExt: Pt has amputation below the knee on left and missing two \nlateral digits on RLE, warm, well perfused, 2+ pulses, no \nclubbing, cyanosis or edema", 'diagnoses': [{'icd_code': '73008', 'desc': 'Acute osteomyelitis, other specified sites'}, {'icd_code': '56731', 'desc': 'Psoas muscle abscess'}, {'icd_code': '3241', 'desc': 'Intraspinal abscess'}, {'icd_code': '56738', 'desc': 'Other retroperitoneal abscess'}, {'icd_code': '2536', 'desc': 'Other disorders of neurohypophysis'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '5601', 'desc': 'Paralytic ileus'}, {'icd_code': '04111', 'desc': 'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}, {'icd_code': '9974', 'desc': 'Digestive system complications, not elsewhere classified'}, {'icd_code': '30550', 'desc': 'Opioid abuse, unspecified'}, {'icd_code': '72293', 'desc': 'Other and unspecified disc disorder, lumbar region'}, {'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': "___ 11:15PM BLOOD WBC-13.7* RBC-3.48* Hgb-7.5* Hct-24.8* \nMCV-71* MCH-21.7* MCHC-30.4* RDW-18.4* Plt ___\n___ 05:40AM BLOOD WBC-7.8 RBC-3.50* Hgb-8.6* Hct-26.7* \nMCV-76* MCH-24.5* MCHC-32.2 RDW-19.4* Plt ___\n___ 11:15PM BLOOD Neuts-81.0* Lymphs-13.2* Monos-4.4 \nEos-1.2 Baso-0.2\n___ 06:20AM BLOOD Neuts-74.9* Lymphs-15.0* Monos-5.6 \nEos-4.3* Baso-0.3\n___ 11:15PM BLOOD ___ PTT-108.8* ___\n___ 05:40AM BLOOD ___ PTT-29.7 ___\n___:15PM BLOOD Glucose-241* UreaN-47* Creat-2.2* Na-134 \nK-5.2* Cl-103 HCO3-20* AnGap-16\n___ 05:40AM BLOOD Glucose-106* UreaN-15 Creat-1.3* Na-133 \nK-4.5 Cl-101 HCO3-24 AnGap-13\n___ 08:17AM BLOOD Calcium-8.8 Phos-3.3 Mg-2.8*\n___ 05:40AM BLOOD Calcium-8.6 Phos-3.0 Mg-2.0\n___ 07:27PM BLOOD Vanco-15.3\n\nBlood Culture, Routine (Final ___: \n CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). \n IDENTIFIED AS CORYNEBACTERIUM AURIMUCOSUM , Identified \nby ___\n ___. FINAL SENSITIVITIES. \n Sensitivity testing performed by Sensititre. \n ERYTHROMYCIN > 4 MCG/ML. \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. \n FINAL SENSITIVITIES COAG NEG STAPH does NOT require \ncontact\n precautions, regardless of resistance. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four days after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n CORYNEBACTERIUM SPECIES \n(DIPHTHEROIDS)\n | STAPHYLOCOCCUS, \nCOAGULASE NEGATIVE\n | | \nCLINDAMYCIN---------- =>8 R\nERYTHROMYCIN---------- R =>8 R\nGENTAMICIN------------ <=2 S <=0.5 S\nLEVOFLOXACIN---------- 0.25 S\nOXACILLIN------------- 2 R\nPENICILLIN G---------- 0.25 S\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- <=1 S\nVANCOMYCIN------------ <=1 S <=0.5 S\n\n Aerobic Bottle Gram Stain (Final ___: \n REPORTED BY PHONE TO ___. ___ ___ ON \n___. \n GRAM POSITIVE ROD(S). \n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. \n\n___ 8:17 am BLOOD CULTURE Source: Line-RIJ #1. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. \n FINAL SENSITIVITIES COAG NEG STAPH does NOT require \ncontact\n precautions, regardless of resistance. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four days after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n CORYNEBACTERIUM SPECIES (DIPHTHEROIDS). \n SENSITIVITIES PERFORMED ON CULTURE # \n___. \n IDENTIFICATION PERFORMED ON CULTURE # ___ ___. \n\n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS, COAGULASE NEGATIVE\n | \nCLINDAMYCIN---------- =>8 R\nERYTHROMYCIN---------- =>8 R\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN---------- 0.25 S\nOXACILLIN------------- 1 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- <=1 S\nVANCOMYCIN------------ 1 S\n\n Aerobic Bottle Gram Stain (Final ___: \n REPORTED BY PHONE TO ___. ___ ___ @ ___ ON \n___. \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. \n GRAM POSITIVE ROD(S). \n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. \n\n___ 5:10 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH.\n\n___ 1:35 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH.\n\nCT ABD/PELVIS ___:\nIMPRESSION: \n1. Retroperitoneal hematoma within the right iliacus and psoas \nmusculature.\nActive extravasation is not assessed without contrast. \n2. Cholelithiasis without CT evidence of cholecystitis. \n3. Poorly characterized thickening of the fundus of the stomach. \nThough \nsimilar in appearance to ___, endoscopy is again \nrecommended for further evaluation, if not already performed. \n4. Thoracolumbar degenerative change, without fracture. \n \nECHO ___:\nThe left atrium is normal in size. Left ventricular wall \nthicknesses and cavity size are normal. Due to suboptimal \ntechnical quality, a focal wall motion abnormality cannot be \nfully excluded. Overall left ventricular systolic function is \nnormal (LVEF>55%). Right ventricular chamber size and free wall \nmotion are normal. A bileaflet aortic valve prosthesis is \npresent. The transaortic gradient is higher than expected for \nthis type of prosthesis. No masses or vegetations are seen on \nthe aortic valve, but cannot be fully excluded due to suboptimal \nimage quality. Trace aortic regurgitation is seen. The mitral \nvalve leaflets are mildly thickened. There is no mitral valve \nprolapse. No masses or vegetations are seen on the mitral valve, \nbut cannot be fully excluded due to suboptimal image quality. \nThe left ventricular inflow pattern suggests a restrictive \nfilling abnormality, with elevated left atrial pressure. There \nis mild pulmonary artery systolic hypertension. There is no \npericardial effusion. \n\nCompared with the report of the prior study (images unavailable \nfor review) of ___, gradient across the prosthetic aortic \nvalve is similarly high, trace aortic regurgitation is now seen. \nCannot adequately assess prosthetic valve endocarditis by TTE. \nMICU COURSE ___:\n___ year old male who presents to the ED with PMH of AVR for \nendocarditis on coumadin, DM, HLD, CRI baseline Cr 1.5, who \npresented to ED with back pain for two weeks and was found to \nhave a right psoas hematoma on CT scan in setting of \nsupratherapeutic INR to 4 and acute on chronic renal failure. \nHe was admitted to the ICU and his INR was reversed with iv \nvitamin K. his hct dropped from baseline of low 30's to 24. He \nrecevied 2u RBC and 2u plts and his hct rose to 25 and was \nstable. His cardiologist was contacted and agreed with holding \nanticoagulation for several days in setting of bleed. Plan was \nto bridge with heparin to coumadin and monitor inpatient while \nbridging given bleed. His renal failure improved to baseline of \n1.5. Echo done over concern of possible endocarditis given \nslight leukocytosis which showed no endocarditis (can't be fully \nruled out on TTE). Patient is full code. \n\n# Right psoas hematoma: Patient likely developed this in the \nsetting of supratherapeutic INR found to be 8.4 on admission. \nHis INR was reversed by IV vitamin K in the ED and he was \ntransferred to the MICU for monitoring. He received 2units of \npRBC and 2 units of pltlts and pt stabilized. His \nanticoagulation was held in the setting of psoas bleed. His \nbleeding remained stbale and pt was transferred to the floor. \nWhile on the floor the patient did not require any transfusions. \n His vital signs were stable and he was increasingly able to \nmove his right leg with minimal pain. At time of discharge pt \nhad near normal range of motion of his right psoas with no pain \nwhen the psoas muscle was isolated and stressed on physical \nexam. He was discharged to home with close follow up.\n. \n# AVR: Pt anticoagulation for AVR was stopped secondary to \nsupratherapuetic INR and psoas hematoma. After pt hematoma \nstabilized, vital signs were stable and patient was transferred \nto the floor he was started on a heparin drip and bridged over \nto coumadin. There were no complications related to the short \ndiscontinuation of his warfarin therapy and there were no \ncomplications with his AVR.\n \n# DMII: Patient on insulin at home. His home doses of insulin \nwere continued in addition to a prandial insulin sliding scale. \n___ and blood sugars were checked and were well controlled \nthrough his hospital course. \n. \n# Acute on Chronic renal failure: Pt has a baseline Cr of 1.5 \nprior to admission and on admission it was elevated to 2.2. As \npt was treated his Cr trended down back to baseline. This acute \nrise in Cr was likely secondary to hypovolemia in the setting of \na large psoas hematoma.\n\nPt was discharged to home therapuetic on heparin with close \nfollow up with his PCP."}}
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{'final_diagnoses': ['Psoas hematoma'], 'procedures': ['None'], 'visit_summary': "MICU COURSE ___:\n___ year old male who presents to the ED with PMH of AVR for \nendocarditis on coumadin, DM, HLD, CRI baseline Cr 1.5, who \npresented to ED with back pain for two weeks and was found to \nhave a right psoas hematoma on CT scan in setting of \nsupratherapeutic INR to 4 and acute on chronic renal failure. \nHe was admitted to the ICU and his INR was reversed with iv \nvitamin K. his hct dropped from baseline of low 30's to 24. He \nrecevied 2u RBC and 2u plts and his hct rose to 25 and was \nstable. His cardiologist was contacted and agreed with holding \nanticoagulation for several days in setting of bleed. Plan was \nto bridge with heparin to coumadin and monitor inpatient while \nbridging given bleed. His renal failure improved to baseline of \n1.5. Echo done over concern of possible endocarditis given \nslight leukocytosis which showed no endocarditis (can't be fully \nruled out on TTE). Patient is full code. \n\n# Right psoas hematoma: Patient likely developed this in the \nsetting of supratherapeutic INR found to be 8.4 on admission. \nHis INR was reversed by IV vitamin K in the ED and he was \ntransferred to the MICU for monitoring. He received 2units of \npRBC and 2 units of pltlts and pt stabilized. His \nanticoagulation was held in the setting of psoas bleed. His \nbleeding remained stbale and pt was transferred to the floor. \nWhile on the floor the patient did not require any transfusions. \n His vital signs were stable and he was increasingly able to \nmove his right leg with minimal pain. At time of discharge pt \nhad near normal range of motion of his right psoas with no pain \nwhen the psoas muscle was isolated and stressed on physical \nexam. He was discharged to home with close follow up.\n. \n# AVR: Pt anticoagulation for AVR was stopped secondary to \nsupratherapuetic INR and psoas hematoma. After pt hematoma \nstabilized, vital signs were stable and patient was transferred \nto the floor he was started on a heparin drip and bridged over \nto coumadin. There were no complications related to the short \ndiscontinuation of his warfarin therapy and there were no \ncomplications with his AVR.\n \n# DMII: Patient on insulin at home. His home doses of insulin \nwere continued in addition to a prandial insulin sliding scale. \n___ and blood sugars were checked and were well controlled \nthrough his hospital course. \n. \n# Acute on Chronic renal failure: Pt has a baseline Cr of 1.5 \nprior to admission and on admission it was elevated to 2.2. As \npt was treated his Cr trended down back to baseline. This acute \nrise in Cr was likely secondary to hypovolemia in the setting of \na large psoas hematoma.\n\nPt was discharged to home therapuetic on heparin with close \nfollow up with his PCP.", 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', 'Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours).\nDisp:*2 Tablet(s)* Refills:*0*', 'Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.', 'Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.', 'Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice a day.', 'Simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime.', 'Outpatient Lab Work\nPatient should have INR drawn every other day with his first INR \ndrawn tomorrow ___', 'Warfarin 5 mg Tablet Sig: 1.5 Tablets 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': 76, 'gender': 'M', 'symptoms': 'Morbid obesity', 'medical_history': ['1) polycystic ovary syndrome', '2) sickle cell trait', '3) chronic constipation', '4) hyperlipidemia with elevated triglycerides', '5) vitamin D deficiency', '6) iron deficiency with saturation of 9%', '7) hyperuricemia', '8) history of cellulitis', '9) history of herpes simplex oral', '10) history of rectal bleeding (anoscopy noted internal \n hemorrhoid and small rectal ulcer)', '11) history of otitis media', '12) obstructive sleep apnea recently placed on CPAP', '13) varicella at the age of ___', '14) uterine polyps', '15) thrombocytosis'], 'family_history': 'Her family history is noted for father living age ___ with \nhypertension, osteoarthritis, diabetes and obesity; mother \nliving age ___ with hypertension, hypothyroidism and obesity; 2 \nbrothers one deceased age ___ sickle cell disease.', 'present_illness': 'Per Dr. ___ has class III morbid obesity with \nweight of 330.1 pounds as of ___ with her initial screen \nweight of 341.3 pounds on ___, height 66.75 inches and BMI \nof 52.1. Her previous weight loss efforts has included \nover-the-counter dietary supplement Herbalife in the form of \npills and shakes, self-directed diets, RD visits multiple times \nwith multiple providers and has lost up to 25 pounds but her \nweight loss attempts have failed to produce lasting results. \nShe has not taken prescription weight loss medications. She \nstated that she weighed around 182 as much as 200 pounds in her \nlate teens. She has been struggling with weight her whole life \nand cites his factors contributing to her excess weight large \nportions, grazing, late-night eating, emotional eating ___ times \na week, too many carbohydrates and sweets and lack of exercise. \nShe walks her dog twice a day for ___ hours. She denied history \nof eating disorders - no anorexia, bulimia, diuretic or laxative\nabuse but she did admit to binge eating without purging. She \ndoes not have a clinical diagnosis of depression except for \nsituational around her weight and she had been followed by a \ntherapist in ___, has not been hospitalized for mental health \nissues and she is not on any psychotropic medications.', 'medications': [{'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Protamine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin EC', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'GlyBURIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': '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 via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 2.0}, {'medication': 'GlyBURIDE', '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', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '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': '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': '367', 'valuenum': 367.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '122', 'valuenum': 122.0, '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': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '148', 'valuenum': 148.0, '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': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': '169', 'valuenum': 169.0, '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': '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': '369', 'valuenum': 369.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '26.5', 'valuenum': 26.5, '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': '30.4', 'valuenum': 30.4, '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': '194', 'valuenum': 194.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '16.7', 'valuenum': 16.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.08', 'valuenum': 1.08, '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': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '312', 'valuenum': 312.0, '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': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-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': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 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'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': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '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': '216', 'valuenum': 216.0, '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': '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, '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': '3.8', 'valuenum': 3.8, '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': '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': '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': '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': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '338', 'valuenum': 338.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': '___ resident exam:\nVS: ___ 0408 Temp: 98.2 PO BP: 138/88 HR: 60 RR: 18 O2 sat:\n100% O2 delivery: Ra \nGEN: A&Ox3, NAD, resting comfortably \nHEENT: NCAT, EOMI, sclera anicteric\nCV: RRR\nPULM: no respiratory distress\nABD: soft, NT, ND, no rebound or guarding \nEXT: warm, well-perfused, no edema \nPSYCH: normal insight, memory, and mood\nWOUND(S): Incision c/d/I w/ minimal staining.', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '2869', 'desc': 'Other and unspecified coagulation defects'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': '99939', 'desc': 'Infection following other infusion, injection, transfusion, or vaccination'}, {'icd_code': '6824', 'desc': 'Cellulitis and abscess of hand, except fingers and thumb'}, {'icd_code': '41072', 'desc': 'Subendocardial infarction, subsequent episode of care'}, {'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': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '45829', 'desc': 'Other iatrogenic hypotension'}, {'icd_code': 'E8798', 'desc': 'Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}], 'summary': "___ 03:56AM BLOOD Hct-37.3\n___ 12:21PM BLOOD Hct-39.5\nThe patient presented to pre-op on ___. Patient was \nevaluated by anaesthesia. The patient was taken to the \noperating room for a laparoscopic sleeve gastrectomy for \nobesity. There were no adverse events in the operating room; \nplease see the operative note for details. Pt was extubated, \ntaken to the PACU until stable, then transferred to the ward for \nobservation. \n Neuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA. Pain was \nvery well controlled. The patient was then transitioned to \nliquid oral pain medication once tolerating a stage 3 diet. \n CV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored. \n Pulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \n GI/GU/FEN: The patient was initially kept NPO. Afterwards, the \npatient was started on a stage 1 bariatric diet, which the \npatient tolerated well. Subsequently, the patient was advanced \nto stage 2, and then stage 3 diet which the patient was \ntolerating on day of discharge. \n ID: The patient's fever curves were closely watched for signs \nof infection, of which there were none. \n HEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none. \n Prophylaxis: 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 At the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a \nbariatric stage 3 diet, ambulating, voiding without assistance, \nand pain was well controlled. The patient received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan."}}
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{'final_diagnoses': ['Morbid obesity'], 'procedures': ['___: laparoscopic sleeve gastrectomy'], 'visit_summary': "The patient presented to pre-op on ___. Patient was \nevaluated by anaesthesia. The patient was taken to the \noperating room for a laparoscopic sleeve gastrectomy for \nobesity. There were no adverse events in the operating room; \nplease see the operative note for details. Pt was extubated, \ntaken to the PACU until stable, then transferred to the ward for \nobservation. \n Neuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA. Pain was \nvery well controlled. The patient was then transitioned to \nliquid oral pain medication once tolerating a stage 3 diet. \n CV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored. \n Pulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \n GI/GU/FEN: The patient was initially kept NPO. Afterwards, the \npatient was started on a stage 1 bariatric diet, which the \npatient tolerated well. Subsequently, the patient was advanced \nto stage 2, and then stage 3 diet which the patient was \ntolerating on day of discharge. \n ID: The patient's fever curves were closely watched for signs \nof infection, of which there were none. \n HEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none. \n Prophylaxis: 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 At the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a \nbariatric stage 3 diet, ambulating, voiding without assistance, \nand pain was well controlled. The patient received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan.", 'medications_prescribed': ['1. Docusate Sodium (Liquid) 100 mg PO BID:PRN constipation \nRX *docusate sodium [Diocto] 50 mg/5 mL 10 ml by mouth twice a \nday Refills:*0 ', '2. Famotidine 20 mg PO BID \nRX *famotidine 20 mg 1 tablet(s) by mouth every twelve (12) \nhours Disp #*60 Tablet Refills:*0 ', '3. OxycoDONE Liquid 5 mg PO Q4H:PRN Pain - Moderate \nRX *oxycodone 5 mg/5 mL 5 mg by mouth every four (4) hours \nRefills:*0 ', '4. Acetaminophen 1000 mg PO ASDIR ', '5. levonorgestrel 20 mcg/24 hr ___ years) injection ASDIR ', '6. 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': 30, 'gender': 'F', 'symptoms': 'Erectile dysfunction', 'medical_history': ['* Rheumatoid arthritis (CCP+)', '* GERD', '* Hiatal hernia', '* Lung cancer (adenocarcinoma) s/p RUL wedge resection, LLL \nlobectomy (___)', '* Bilateral orchiectomy: Right for cryptorchism (___), left for \nnodule with splenic tissue on pathology (___)', '* Hypertension', '* Allergic rhinitis', '* Asthma', '* Cataracts', '* Benign prostatic hypertrophy (s/p TURP ___', '* Carpal tunnel syndrome s/p right hand surgeries (___)'], 'family_history': 'Father died of lung cancer. ___ siblings have died of: Sister - \nlung cancer ___ hand smoke), Sister - SLE, Sister - Multiple \nCVAs, Brother - lung cancer, Brother - bad heart, Brother - \nbrain cancer. No family history of sudden cardiac death, MI.', 'present_illness': '___ with ED s/p IPP', 'medications': [{'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pregabalin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ON CALL TO OR', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cepacol (Sore Throat Lozenge)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': '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', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ON CALL TO OR', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', '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:PRN', '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': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '___', '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.1', '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': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '3.55', 'valuenum': 3.55, 'valueuom': 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'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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '7', 'valuenum': 7.0, '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}], 'exams': 'WdWn male, NAD, AVSS\nInteractive, cooperative\nAbdomen soft, Nt/Nd\nIncision c/d/i w/out evidence hematoma or infection\nEcchymosis at penile shaft/scrotum noted but without induration\nLower extremities w/out edema or pitting and no report of calf \npain', 'diagnoses': [{'icd_code': 'G9761', 'desc': 'Postprocedural hematoma of a nervous system organ or structure following a nervous system procedure'}, {'icd_code': 'G935', 'desc': 'Compression of brain'}, {'icd_code': 'I6203', 'desc': 'Nontraumatic chronic subdural hemorrhage'}, {'icd_code': 'R402362', 'desc': 'Coma scale, best motor response, obeys commands, at arrival to emergency department'}, {'icd_code': 'R402142', 'desc': 'Coma scale, eyes open, spontaneous, at arrival to emergency department'}, {'icd_code': 'R402252', 'desc': 'Coma scale, best verbal response, oriented, at arrival to emergency department'}, {'icd_code': 'O1495', 'desc': 'Unspecified pre-eclampsia, complicating the puerperium'}, {'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'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}], 'summary': "___ 08:15AM BLOOD WBC-20.5*# RBC-4.71 Hgb-15.5 Hct-46.0 \nMCV-98 MCH-33.0* MCHC-33.7 RDW-13.7 Plt ___\n\n___ 08:15AM BLOOD Glucose-81 UreaN-13 Creat-0.8 Na-135 \nK-4.2 Cl-100 HCO3-27 AnGap-12\nMr. ___ was admitted to Dr. ___ service for \nplacement of penile prosthesis. No concerning intraoperative \nevents occurred; please see dictated operative note for details. \nThe patient received vancomycin and gentamicin for pre-operative \ninfection prophylaxis and post-operatively for prophylaxis. \nPost-op course was uncomplicated. His foley catheter was removed \non POD#1 and the patient voided without difficulty. At \ndischarge, patient's pain was well controlled with oral pain \nmedications, tolerating regular diet, ambulating without \nassistance, and voiding without difficulty. Incision at \ndischarge without erythema or hematoma. Specific instructions \nabout prosthesis care given, and also included in this discharge \nsummary."}}
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{'final_diagnoses': ['Erectile Dysfunction'], 'procedures': ['Insertion of inflatable penile prosthesis'], 'visit_summary': "Mr. ___ was admitted to Dr. ___ service for \nplacement of penile prosthesis. No concerning intraoperative \nevents occurred; please see dictated operative note for details. \nThe patient received vancomycin and gentamicin for pre-operative \ninfection prophylaxis and post-operatively for prophylaxis. \nPost-op course was uncomplicated. His foley catheter was removed \non POD#1 and the patient voided without difficulty. At \ndischarge, patient's pain was well controlled with oral pain \nmedications, tolerating regular diet, ambulating without \nassistance, and voiding without difficulty. Incision at \ndischarge without erythema or hematoma. Specific instructions \nabout prosthesis care given, and also included in this discharge \nsummary.", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN pain', '2. Albuterol Inhaler 1 PUFF IH Q6H:PRN wheezes', '3. Amlodipine 10 mg PO DAILY', '4. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES BID', '5. Fluticasone Propionate 110mcg 2 PUFF IH DAILY', '6. Fluticasone Propionate NASAL 1 SPRY NU DAILY', '7. Losartan Potassium 100 mg PO DAILY', '8. Omeprazole 20 mg PO DAILY', '9. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp \n#*25 Tablet Refills:*0', '10. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*60 Capsule Refills:*0', '11. Ciprofloxacin HCl 500 mg PO Q12H \nRX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) \nhours Disp #*14 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'F', 'symptoms': 'Chest pain', 'medical_history': ['Hyperlipidemia', 'Coronary artery disease', 'Mild cardiomyopathy', 'Spinal stenosis', 'Chronic back pain d/t being hit by a truck ___ years ago', 'Fatty liver', 'Sleep apnea-diagnosed, however, resolved since weight loss', 'Chronic Interstitial pulmonary fibrosis-will be followed by\nroutine CT scans', 'Thrombocytopenia- s/p bone marrow biopsy ___, chemo\ntherapy x 4 treatments and prednisone therapy', 'Skin cancer s/p excision'], 'family_history': 'Premature coronary artery disease- Brother with heart transplant \n@ age ___', 'present_illness': '___ year old male who was initially seen in ___ with a 6 \nmonth history of symptoms. At that time, he reported chest pain, \nchest tightness and shortness of breath with minimal exertion \nrelieved with rest. He was referred for a stress ECHO on ___ which was abnormal and at that time, he was noted to \nhave thrombocytopenia for which he was sent for evaluation. He \nwas treated with chemotherapy and prednisone therapy. His \nplatelets are currently considered stable for antiplatelet \ntherapy. Currently, he reports that symptoms have resolved \nsince losing 30 pounds. He was referred for cardiac \ncatheterization for further evaluation. He was found to have \ncoronary artery disease upon catheterization and is now being \nreferred to cardiac surgery for revascularization.', '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': 'Levothyroxine Sodium', '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': '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': '___', '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': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', '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': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.54', 'valuenum': 4.54, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse:53 Resp:18 O2 sat:99/RA \nB/P Right:127/84 Left:133/84 \nHeight:5\'9" Weight:215 lbs\n\nGeneral:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [x] Murmur [] grade ______ \nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds\n+ [x]\nExtremities: Warm [x], well-perfused [x] Edema [] _____\nVaricosities: None []\nNeuro: Grossly intact [x]\nPulses: all palpable', 'diagnoses': [{'icd_code': 'I951', 'desc': 'Orthostatic hypotension'}, {'icd_code': 'M25512', 'desc': 'Pain in left shoulder'}, {'icd_code': 'R42', 'desc': 'Dizziness and giddiness'}, {'icd_code': 'R51', 'desc': 'Headache'}, {'icd_code': 'M25562', 'desc': 'Pain in left knee'}, {'icd_code': 'S0990XA', 'desc': 'Unspecified injury of head, initial encounter'}, {'icd_code': 'W1839XA', 'desc': 'Other fall on same level, initial encounter'}, {'icd_code': 'Y9389', 'desc': 'Activity, other specified'}, {'icd_code': 'Z8241', 'desc': 'Family history of sudden cardiac death'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': '___ Echo: PRE-CPB: 1. The left atrium is mildly dilated. No \nthrombus is seen in the left atrial appendage. 2. The right \natrium is moderately dilated. 3. No atrial septal defect is seen \nby 2D or color Doppler. 4. The right ventricular free wall is \nhypertrophied. The right ventricular cavity is moderately \ndilated with normal free wall contractility. 5. The ascending, \ntransverse and descending thoracic aorta are normal in diameter \nand free of atherosclerotic plaque. There are simple atheroma in \nthe aortic arch. There are simple atheroma in the descending \nthoracic aorta. \n6. There are three aortic valve leaflets. The aortic valve \nleaflets (3) are mildly thickened. There is no aortic valve \nstenosis. Mild (1+) aortic regurgitation is seen. 7. Mild (1+) \nmitral regurgitation is seen. \n\nPOST CPB: On infusion of phenylephrine. A pacing for slow sinus. \nPreserved biventricular systolic function with LVEF = 50 %. MR \nis trace, AI is 1+. The aortic contour is normal post \ndecannulation.\n\nCXR: ___: IMPRESSION: PA and lateral chest \nOnly mild residual interstitial pulmonary edema remains, \npostoperative \nwidening of the cardiomediastinal silhouette is stable, and \nthere is \nmoderate-to-severe bibasilar atelectasis, left greater than \nright. There is no pneumothorax. \n\n___ WBC-7.6 RBC-3.49* Hgb-10.0* Hct-29.3* MCV-84 MCH-28.6 \nMCHC-34.1 RDW-14.3 Plt ___\n___ WBC-15.1*# RBC-3.61* Hgb-10.3* Hct-30.4* MCV-84 \nMCH-28.4 MCHC-33.7 RDW-13.8 Plt Ct-75*\n___ Glucose-183* UreaN-14 Creat-0.7 Na-135 K-3.4 Cl-99 \nHCO3-27 \n___ UreaN-12 Creat-0.7 Na-142 K-3.8 Cl-111* HCO3-26\nMr. ___ was a same day admit after undergoing pre-operative \nwork-up at the time of his cardiac cath. On ___ he was brought \nto the operating room where he underwent a coronary artery \nbypass graft x 3. Please see operative report for surgical \ndetails. Following surgery he was transferred to the CVICU for \ninvasive monitoring in stable condition. Within 24 hours he was \nweaned from sedation, awoke neurologically intact and extubated. \nOn post-op day one he was started on beta-blockers and diuretics \nand diuresed towards his pre-op weight. Later on this day he was \ntransferred to the step-down unit for further recovery. Chest \ntubes and epicardial pacing wires were removed per protocol. His \npain was well controlled with Tramadol. Foley replaced for 1 \nLiter of urinary retention, flomax was started x 24 hours \nsubsquently removed and he voided. Blood sugars were less than \n150. He was followed by Physical therapy who recommended rehab. \n He continued to make steady progress and was discharged to \n___ in ___.'}}
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{'final_diagnoses': ['Coronary artery disease s/p Coronary artery bypass graft x 3', 'Past medical history:', 'Hyperlipidemia', 'Mild cardiomyopathy', 'Spinal stenosis', 'Chronic back pain d/t being hit by a truck ___ years ago', 'Fatty liver', 'Sleep apnea-diagnosed, however, resolved since weight loss', 'Chronic Interstitial pulmonary fibrosis-will be followed by \nroutine CT scans', 'Thrombocytopenia- s/p bone marrow biopsy ___, chemo \ntherapy x 4 treatments and prednisone therapy', 'Skin cancer s/p excision'], 'procedures': ['___ Coronary artery bypass grafting times 3 with a reverse \nsaphenous vein graft from the aorta to the left anterior \ndescending coronary artery; reverse saphenous vein graft from \naorta to the first obtuse marginal coronary artery; reverse \nsaphenous vein graft from the aorta to the posterior descending \ncoronary artery'], 'visit_summary': 'Mr. ___ was a same day admit after undergoing pre-operative \nwork-up at the time of his cardiac cath. On ___ he was brought \nto the operating room where he underwent a coronary artery \nbypass graft x 3. Please see operative report for surgical \ndetails. Following surgery he was transferred to the CVICU for \ninvasive monitoring in stable condition. Within 24 hours he was \nweaned from sedation, awoke neurologically intact and extubated. \nOn post-op day one he was started on beta-blockers and diuretics \nand diuresed towards his pre-op weight. Later on this day he was \ntransferred to the step-down unit for further recovery. Chest \ntubes and epicardial pacing wires were removed per protocol. His \npain was well controlled with Tramadol. Foley replaced for 1 \nLiter of urinary retention, flomax was started x 24 hours \nsubsquently removed and he voided. Blood sugars were less than \n150. He was followed by Physical therapy who recommended rehab. \n He continued to make steady progress and was discharged to \n___ in ___.', 'medications_prescribed': ['1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', '2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).', '3. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.', '5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO HS (at bedtime) as needed for constipation.', '6. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \nDAILY (Daily) as needed for constipation.', '7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every \n4 hours) as needed for pain/fever.', '8. tramadol 50 mg Tablet Sig: One (1) Tablet PO every ___ hours \nas needed for pain.', '9. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '10. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) \nCapsule, Ext Release 24 hr PO HS (at bedtime).', '11. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day \nfor 5 days.', '12. potassium chloride 10 mEq Tablet Extended Release Sig: One \n(1) Tablet Extended Release PO once a day for 5 days.', '13. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).']}
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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': '___ yo M with bladder cancer s/p cystectomy and ileal conduit \npresents with right PCN placed for hyronephrosis', 'medical_history': ['CAD, s/p myocardial infarction, CABG ___', 'hypertension', 'bladder and prostate cancer', 'PVD s/p peripheral stent ___, R Fem-Pop', 'GERD', 'Hypothyroidism', 'L1 compression Fx', 'AAA, 3.1 cm on observation'], 'family_history': 'Unremarkable', 'present_illness': None, 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Phytonadione', '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': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', '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': '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': '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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'Discontinued', 'route': 'PR', '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': 'Heparin Flush (10 units/ml)', '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': '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, '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': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.1', 'valuenum': 84.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 66.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': 'VERY LOW.'}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '364', 'valuenum': 364.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3257', 'valuenum': 3257.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '737', 'valuenum': 737.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.11, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '400', 'valuenum': 400.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '16/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 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'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '306', 'valuenum': 306.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, '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': '161', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, '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': '-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': '1.8', 'valuenum': 1.8, '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': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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 - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', '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': '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': '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': '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': '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': '68', 'valuenum': 68.0, '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': '643', 'valuenum': 643.0, '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': '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': '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '___', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '100', 'valuenum': 100.0, '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': '24/10.', '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': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, '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': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.5', 'valuenum': 45.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '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': '146', 'valuenum': 146.0, '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': '2.9', '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': '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': '-6', 'valuenum': -6.0, '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': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': 'abnormal', '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': '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': '597', 'valuenum': 597.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.10', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.7', 'valuenum': 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'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': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, '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': 4.2, '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': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, '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': '118', 'valuenum': 118.0, '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': '3.2', 'valuenum': 3.2, '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': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '340', 'valuenum': 340.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '796', 'valuenum': 796.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.22, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.2', 'valuenum': 53.2, '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': 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': '59', 'valuenum': 59.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.13, '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': '83', 'valuenum': 83.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 29.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '-11', 'valuenum': -11.0, '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': '___', 'valuenum': 7.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 70.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 7.07, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'NAD, no resp distress, AVSS\nR chest tube site without erythema, approp tender\nRight PCN clamped\nABD soft, minimal tenderness, no guarding/rebound\nurostomy pink/viable\nlower extremities w/out edema', 'diagnoses': [{'icd_code': '78551', 'desc': 'Cardiogenic shock'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '99731', 'desc': 'Ventilator associated pneumonia'}, {'icd_code': '5128', 'desc': 'Other spontaneous pneumothorax'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '33399', 'desc': 'Other extrapyramidal diseases and abnormal movement disorders'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'E9478', 'desc': 'Other drugs and medicinal substances causing adverse effects in therapeutic use'}], 'summary': '___ 11:40AM BLOOD WBC-13.5* RBC-3.33* Hgb-10.3* Hct-30.0* \nMCV-90 MCH-31.0 MCHC-34.5 RDW-15.3 Plt ___\n___ 06:40AM BLOOD WBC-12.0* RBC-3.02* Hgb-9.4* Hct-27.4* \nMCV-91 MCH-31.0 MCHC-34.3 RDW-15.5 Plt ___\n___ 06:00PM BLOOD WBC-9.3 RBC-3.26* Hgb-10.1* Hct-29.0* \nMCV-89 MCH-31.1 MCHC-34.9 RDW-14.9 Plt ___\n___ 06:10AM BLOOD Glucose-103* UreaN-10 Creat-0.9 Na-133 \nK-4.6 Cl-99 HCO3-22 AnGap-17\n___ 06:40AM BLOOD Glucose-110* UreaN-14 Creat-0.9 Na-131* \nK-5.3* Cl-99 HCO3-23 AnGap-14\n___ 06:10AM BLOOD Calcium-9.5 Mg-1.5*\n___ 06:40AM BLOOD Calcium-9.1 Mg-1.5*\n___ with bladder cancer s/p robotic cystoprostatectomy ___\nwith ileal conduit diagnosed recently with UTI at OSH ___\n___, ___) that prompted a CT and PCN placement on R for\nhydro during which a central line placement was complicated by\npneumothorax. Chest tube was placed (has been removed). He was\ndischarged from ___ and presented to ___ as direct\nadmission and his wife brings imaging disc and all relevant\ndocumentation from his hospital course in ___. He\narrives here for antegrade study by ___ and further management\nand he arrived w/out F/C/N/V, hematuria, SOB, CP at present.\n\nHe was evaluated by the ___ team and on ___, hospital day 2, he\nunderwent OB \nBalloon dilatation of the distal ureteral stricture and\nsuccessful conversion of the nephrostomy for the Nephro-ureteral\nstent. He remained ovenight for further observation and\nmanagement and wound care. He was discharged on ___ to\nhome with resumption of his visiting nurse ___ for\nassistance with this transition and continued care of his\nnephrostomy tube site and urostomy. At time of discharge his\npain was well controlled with oral analgesics, he was tolerating\na regular diet with ensure supplements and he was ambulating at\nbaseline with assistance.'}}
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{'final_diagnoses': ['ureteral stricture'], 'procedures': ['___: PCN change and placement of nephro-ureteral stent'], 'visit_summary': '___ with bladder cancer s/p robotic cystoprostatectomy ___\nwith ileal conduit diagnosed recently with UTI at OSH ___\n___, ___) that prompted a CT and PCN placement on R for\nhydro during which a central line placement was complicated by\npneumothorax. Chest tube was placed (has been removed). He was\ndischarged from ___ and presented to ___ as direct\nadmission and his wife brings imaging disc and all relevant\ndocumentation from his hospital course in ___. He\narrives here for antegrade study by ___ and further management\nand he arrived w/out F/C/N/V, hematuria, SOB, CP at present.\n\nHe was evaluated by the ___ team and on ___, hospital day 2, he\nunderwent OB \nBalloon dilatation of the distal ureteral stricture and\nsuccessful conversion of the nephrostomy for the Nephro-ureteral\nstent. He remained ovenight for further observation and\nmanagement and wound care. He was discharged on ___ to\nhome with resumption of his visiting nurse ___ for\nassistance with this transition and continued care of his\nnephrostomy tube site and urostomy. At time of discharge his\npain was well controlled with oral analgesics, he was tolerating\na regular diet with ensure supplements and he was ambulating at\nbaseline with assistance.', 'medications_prescribed': ['1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours) as needed for pain, temp>99. ', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '3. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1) \nTablet PO Q12H (every 12 hours) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '4. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '5. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '6. fexofenadine 60 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily). ', '7. fluconazole 100 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours) for 7 days. Tablet(s) ', '8. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '9. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '10. multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '11. oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours) \nas needed for pain.\nDisp:*20 Tablet(s)* Refills:*0*', '12. spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '13. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO BID (2 times a day). ', '14. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '15. ascorbic acid ___ mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '16. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) \nTablet PO BID (2 times a day) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '17. Keflex ___ mg Capsule Sig: One (1) Capsule PO once a day: \nStart ___ and continue taking until Dr ___ you to stop.\nDisp:*30 Capsule(s)* Refills:*1*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 77, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['-metastatic melanoma diagnosed in ___. Had surgery to remove \npart of left lung. also had ___ LN positive in neck. No XRT or \nchemo.', '- per OMR: hepatitis B and C with known cirrhosis and liver bx \n___ years ago complicated by right pneuothorax', '- crainotomy during Veitnam for shrapnel injury', '- IDDM', '- osteomyelitis of the toe s/p surgery', '-HTN', '- CHF - ___ ECHO very poor study, but nl EF', '-CAD- has "40% blockage" but again not sure where- one old OMR \nnote says distal Left main artery. He says his last stress test \nwas about ___ years ago at ___', '-s/p appendectomy', '- 4 compresson fracture', '- GERD', '- OSA'], 'family_history': 'Notable for prostate cancer with his father dying of the disease \nat age ___. He had a sister who died at age ___ of a gynecologic \nmalignancy and another sister who died in her ___ of hepatic \nmalignancy. He has a ___ son and an ___ \ndaughter, both of which are healthy.', 'present_illness': '___ yo M with PMH of metastatic melanoma dx in ___ s/p left \npartial lung lobectomy, CAD, CHF (per patient, but last ECHO \n___ poor study but nl?), IDDM who presents with worsening chest \npain. He reports that the chest pain has been present for ___ \nyears but has been progressively worse over the last four \nmonths. He says it is present at baseline all the time in the \nLUQ and below his left breast area. When it is worse, it \nradiates up to his epigastric and lower substernal area. The LUQ \npain is worse with palpation. The pain can be exacerbated by \nmovement. Worse with walking up stairs. He will become SOB with \nexertion as well. He has been taking about 4 nitro per day which \nhelps somewhat with the pain. At its worst the pain feels like a \ntightness which is going to make him pass out. No n/v, \ndiaphoresis or palpitations. \n. \nIn the ED, T 97.3, BP 150/53, HR 71, RR 11, O2sat 97% RA. He was \ngiven asa 325mg x1, insulin regular 10 units, oxycontin 80mg PO \nx1. He had a CXR and one set of CE which was negative. \n. \nCurrently, he says the pain is at baseline ___. But he reports \nhe \n"hurts all over" because he has not had his methadone for pain \ntoday. His neuropathy is also acting up in his legs. He denies \nn/v/SOB, f/c, diarrhea, hematuria, dysuria. +constipation.', 'medications': [{'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', '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', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY INCREASES THIS RESULT.'}, {'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': '84', 'valuenum': 84.0, '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': '___', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': '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': '10.9', 'valuenum': 10.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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 = 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': 234.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 462.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS ELEVATES LDH.'}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, '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': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '1.32', 'valuenum': 1.32, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', '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': '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', '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': '28.4', 'valuenum': 28.4, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, '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': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '241', 'valuenum': 241.0, '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': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'vitals: T 98.6, BP 160/80, HR 76, RR 12, O2sat 97% RA, ___ 338 wt \n321 pounds \nGeneral: NAD obese male. multiple tatoos. no rashes noted. \nHEENT: NCAT, anicteric sclera, non injected conjunctiva, OP \nclear, MMM, neck supple. Difficult to appreciate for JVP given \nbody habitus \nCV: RRR, no m/r/g appreciated \nLungs: CTAB no w/r/r appreciated. Pain to light touch on LUQ and \nepigastric area. With deep palpation, he says it feels like a \nshooting pain around his side on the left. Completely non tender \non LLQ, RLQ and RUQ. no rebound or guarding. No masses palpated \nbut difficult given body habitus. No tenderness to palpation of \nsternal area or upper chest. Also scars healed on left chest and \nlateral side from lobectomy. \nABDOMEN: +BS, soft, non distended. See above for pain \ndiscription. \nEXT: venus status changes and toe amputation. Painful to touch. \nCould not appreciate for pulses because he said it hurt too \nmuch. \nNEURO: CNIII-XII in tact. Strength full throughout.', 'diagnoses': [{'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '1977', 'desc': 'Malignant neoplasm of liver, secondary'}, {'icd_code': '1961', 'desc': 'Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes'}, {'icd_code': '1508', 'desc': 'Malignant neoplasm of other specified part of esophagus'}, {'icd_code': '1971', 'desc': 'Secondary malignant neoplasm of mediastinum'}, {'icd_code': '1973', 'desc': 'Secondary malignant neoplasm of other respiratory organs'}, {'icd_code': '19889', 'desc': 'Secondary malignant neoplasm of other specified sites'}, {'icd_code': '51919', 'desc': 'Other diseases of trachea and bronchus'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '7140', 'desc': 'Rheumatoid arthritis'}, {'icd_code': '3668', 'desc': 'Other cataract'}, {'icd_code': 'V4579', 'desc': 'Other acquired absence of organ'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'V153'}, {'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': 'V5865', 'desc': 'Long-term (current) use of steroids'}], 'summary': "___ 03:30PM BLOOD WBC-9.2 RBC-4.84 Hgb-12.8* Hct-38.8* \nMCV-80* MCH-26.5* MCHC-33.0 RDW-14.0 Plt ___\n___ 03:30PM BLOOD Neuts-62.6 ___ Monos-4.6 Eos-0.8 \nBaso-0.1\n___ 05:40AM BLOOD WBC-9.5 RBC-4.19* Hgb-11.5* Hct-33.9* \nMCV-81* MCH-27.4 MCHC-33.8 RDW-13.7 Plt ___\n\n___ 09:20PM BLOOD Glucose-327* UreaN-18 Creat-1.0 Na-133 \nK-4.0 Cl-94* HCO3-33* AnGap-10\n___ 05:40AM BLOOD Glucose-68* UreaN-15 Creat-0.9 Na-137 \nK-3.9 Cl-95* HCO3-38* AnGap-8\n___ 03:30PM BLOOD ALT-46* AST-37 LD(LDH)-216 AlkPhos-79 \nTotBili-0.6\n___ 06:20PM BLOOD CK(CPK)-138\n___ 03:00AM BLOOD CK(CPK)-79\n___ 06:40AM BLOOD CK(CPK)-80\n___ 10:35AM BLOOD CK(CPK)-70\n___ 06:20PM BLOOD CK-MB-4 cTropnT-<0.01\n___ 03:00AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 06:40AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 10:35AM BLOOD CK-MB-NotDone cTropnT-<0.01\n.\nCardiac Catheterization: \nCOMMENTS: \n1. Selective coronary angiography of this right dominant system \n\ndemonstrated no obstructive CAD. The LMCA had a 20% distal \nstenosis. \nThe LAD had a 30% mid vessel stenosis. The LCx was patent. The \nRCA had \na 30% mid vessel stenosis. \n2. Limited resting hemodynamics revealed an elevated LVEDP of \n20 mmHg. \n3. Left ventriculography revealed no MR. ___ LVEF was \ncalculated to be \n70% with a normal wall motion. \n \nFINAL DIAGNOSIS: \n1. No obstructive coronary disease. \n2. Moderate diastolic ventricular dysfunction. \n3. Normal LV systolic function. \n-----\nCardiac Echo:\nThe left atrium is moderately dilated. Due to suboptimal \ntechnical quality, a focal wall motion abnormality cannot be \nfully excluded. Overall left ventricular systolic function is \nnormal (LVEF>55%). Right ventricular chamber size and free wall \nmotion are normal. The aortic root is mildly dilated at the \nsinus level. The ascending aorta is mildly dilated. The aortic \nvalve leaflets (3) appear structurally normal with good leaflet \nexcursion and no aortic stenosis. There is no pericardial \neffusion. \n\nIMPRESSION: Grossly preserved biventricular function. Very \nlimited study.\n-------\nV/Q Scan:\nThe left lung volume appears lower compared to the right, \nconsistent with \nhistory of partial left lobectomy. No evidence of pulmonary \nembolism. \n-------\nCXR:\nElevation of the left hemidiaphragm and pleural abnormality at \nthe base of the left lung are chronic present postoperatively \nwithout change since ___. Minimal linear scarring or \natelectasis in the left mid lung is also unchanged. Right lung \nis clear. Heart size normal.\nPatient was admitted to the medicine service for management.\n.\n#Exertional Chest Pain and SOB: Presentation was concerning for \nunstable angina given the clear exertional component, relief \nwith NTG and rest, and the patient's risk factors. For this \nreason, Cards was consulted for possible cardiac cath w/o stress \ntest. Cath was performed showing no clinically significant \nlesions, no intervention was made. The question of whether SOB \nmay be related to pulmonary hypertension from chronic OSA and \nprior partial lobectomy or multiple small PE's. Echo was \nperformed that was severely limited in quality but showed no RV \ndysfunction. V/Q Scan was clearly negative for PE, and CXR \nshowed no acute processes. Patient was instructed to continue \nwith medical optimization of his CAD and to follow-up with a \npulmonologist for further evaluation of his SOB.\n.\n#LUQ Pain/Neuropathy: All admission medications conifrmed with \nPCP on admission. CT of the thoracic spine was performed to r/o \npossible radiculopathy from either undrlying spinal disease or \nmetastatic melanoma. MRI not possible due to metal in head. CT \nnegative for any radiculopathy. Pain service consult \nrecommended starting neurontin and tizanadine for neuropathy. \nPatient developed tongue swelling after receiving morning \nmedications. Tizanadine was discontinued, given benadryl, and \nswelling resolved. No other new medications at that time, and \npatient had tolerated neurontin without difficulty in the past. \nImpression on discharge was that patient's LUQ pain was due to \neither pleural based lesions on left side noted on CT scan, \nalthough pain not pleuritic, or to a post-operative neuropathy. \nOf note, patient is very particular about the form of methadone \nhe takes, and had difficulty with the 40mg tablets preferring to \ntake the 10mg tablets as they did not have as strong or rapid \nonset as the larger tablets.\n.\n#Diabetes: Continued on at home regimen. Was hypoglycemic when \nNPO with ___ doses requiring D50 IV.\n.\n#Metastatic Melanoma: Prior to admit CT performed showing \npleural based lesions on left. no evidence of splenic \ninvolvement to explain LUQ pain. Plan for outpatient follow-up.\n."}}
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{'final_diagnoses': ['Chronic Pain', 'Metastatic Melanoma', 'Diabetes', 'Hypertension', 'Atypical Chest Pain'], 'procedures': ['Cardiac Cath'], 'visit_summary': "Patient was admitted to the medicine service for management.\n.\n#Exertional Chest Pain and SOB: Presentation was concerning for \nunstable angina given the clear exertional component, relief \nwith NTG and rest, and the patient's risk factors. For this \nreason, Cards was consulted for possible cardiac cath w/o stress \ntest. Cath was performed showing no clinically significant \nlesions, no intervention was made. The question of whether SOB \nmay be related to pulmonary hypertension from chronic OSA and \nprior partial lobectomy or multiple small PE's. Echo was \nperformed that was severely limited in quality but showed no RV \ndysfunction. V/Q Scan was clearly negative for PE, and CXR \nshowed no acute processes. Patient was instructed to continue \nwith medical optimization of his CAD and to follow-up with a \npulmonologist for further evaluation of his SOB.\n.\n#LUQ Pain/Neuropathy: All admission medications conifrmed with \nPCP on admission. CT of the thoracic spine was performed to r/o \npossible radiculopathy from either undrlying spinal disease or \nmetastatic melanoma. MRI not possible due to metal in head. CT \nnegative for any radiculopathy. Pain service consult \nrecommended starting neurontin and tizanadine for neuropathy. \nPatient developed tongue swelling after receiving morning \nmedications. Tizanadine was discontinued, given benadryl, and \nswelling resolved. No other new medications at that time, and \npatient had tolerated neurontin without difficulty in the past. \nImpression on discharge was that patient's LUQ pain was due to \neither pleural based lesions on left side noted on CT scan, \nalthough pain not pleuritic, or to a post-operative neuropathy. \nOf note, patient is very particular about the form of methadone \nhe takes, and had difficulty with the 40mg tablets preferring to \ntake the 10mg tablets as they did not have as strong or rapid \nonset as the larger tablets.\n.\n#Diabetes: Continued on at home regimen. Was hypoglycemic when \nNPO with ___ doses requiring D50 IV.\n.\n#Metastatic Melanoma: Prior to admit CT performed showing \npleural based lesions on left. no evidence of splenic \ninvolvement to explain LUQ pain. Plan for outpatient follow-up.\n.", 'medications_prescribed': ['1. Influenza Tri-Split ___ Vac 45 mcg/0.5 mL Suspension Sig: \nOne (1) ML Intramuscular ASDIR (AS DIRECTED).', '2. Furosemide 80 mg Tablet Sig: Two (2) Tablet PO QPM (once a \nday (in the evening)).', '3. Furosemide 80 mg Tablet Sig: Two (2) Tablet PO NOON (At \nNoon).', '4. Furosemide 80 mg Tablet Sig: Three (3) Tablet PO QAM (once a \nday (in the morning)).', '5. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, \nChewable PO QID (4 times a day) as needed.', '6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', '7. Senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) \nas needed.', '8. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at \nbedtime).', '9. Temazepam 15 mg Capsule Sig: Two (2) Capsule PO HS (at \nbedtime) as needed.', '10. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '11. Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: Two (2) \nTablet Sustained Release 12 hr PO Q8H (every 8 hours) as needed \nfor pain.', '12. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY \n(Daily).', '13. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '14. Methadone 10 mg Tablet Sig: Thirteen (13) Tablet PO TID (3 \ntimes a day).', '15. Insulin Glargine 100 unit/mL Solution Sig: One Hundred \nThirty (130) qhs Subcutaneous once a day.', '16. Insulin Lispro 100 unit/mL Solution Sig: Fifteen (15) units \nSubcutaneous three times a day: with meals.', '17. Fluvastatin 40 mg Capsule Sig: One (1) Capsule PO at \nbedtime.', '18. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO \nevery eight (8) hours as needed.', '19. Aspirin 81 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': 37, 'gender': 'M', 'symptoms': "crohn's disease involving the terminal ileum", 'medical_history': ["Crohn's disease", 'Polysubstance abuse', 'B12 deficiency', 'Lower back pain.'], 'family_history': 'Father and two brothers - anxiety', 'present_illness': '___ year old male, who presented with recurrent obstructive \nsymptoms that were medically refractory. The patient has had two \nobstructive episodes in ___ years requiring hospitalization \nThe patient has been treated with prednisone and azothiaprim and \nwas no longer on remicade. He was seen in the office by Dr. \n___ recommended a laparoscopic ileocecetomy.', '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': 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 via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propranolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propranolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 58.0, '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': 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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '354', 'valuenum': 354.0, 'valueuom': 'ng/dL', 'ref_range_lower': 80.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 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': '27.9', 'valuenum': 27.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '314', 'valuenum': 314.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, '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': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.6', 'valuenum': 40.6, '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': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.91', 'valuenum': 4.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'General:alert and oriented x 3\nCardiovascular: Regular, Rate, Rhythmn\nPulmonary:Clear\nAbdomen:soft, distended, TTP\nExtremities: warm, dry, intact +2 dorsalis pedis pulse\nWound-abdominal incision', 'diagnoses': [{'icd_code': '24290', 'desc': 'Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm'}, {'icd_code': '7851', 'desc': 'Palpitations'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '7295', 'desc': 'Pain in limb'}], 'summary': '___ 02:13PM SODIUM-140 POTASSIUM-3.2* CHLORIDE-105\n___ 02:13PM MAGNESIUM-1.7\n___ 02:13PM HCT-37.2*\n___ year old male with history of Crohns status post laparoscopic \nconverted to open ileocececetomy admitted to the General Surgery \nInpatient Unit under the care of Dr. ___. \nPostoperatively patient was on a Dilaudid Patient care \nanalgesia. with adewuate pain control. However patient had \npruritis most likelly related to Dilaudid and was started on \nFamotidine and Benadryl. Patient was passing flatus and was \nstarted on clear liquids. He had ___ episodes of loose bowel \nmovements overnight. On postoperative day 2 patient was febrile \nto 102.3 and diaphoretic. Thus had an abdominal/ pelvic CT scan \nwhich showed no evidence of abcess or leak. On postoperative day \n3 was afebrile and continued to pass flatus with diarrhea. He \nhad C. diff test completed 3 consequetive days. On postoperative \nday 4 was feelibng better. On postoperative 5 had increased \nabdominal distension, nausea and vomitting and crampy abdominal \npain with oral intake. On postoperative day 6, he had loose \nstools and he had stool cultures. The diet was backed down to \nclear liquids due to persistent abdominal distension. His \nabdominal distension eventually decreased. The patient \ncomplained of abdominal cramping when he was sitting in the \nchair for long periods of time. Otherwise, the pain decreased \nwith ambulation. On the day of discharge, ___, he was switched \nfrom solumedrol to prednisone 10mg daily. He was asked to follow \nup with his gastroenterology physicians to adjust his dose of \nprednisoneasan outpatient.'}}
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{'final_diagnoses': ["Crohn's disease with obstructive symptoms."], 'procedures': ['Laparoscopy and conversion to open ileocecectomy.'], 'visit_summary': '___ year old male with history of Crohns status post laparoscopic \nconverted to open ileocececetomy admitted to the General Surgery \nInpatient Unit under the care of Dr. ___. \nPostoperatively patient was on a Dilaudid Patient care \nanalgesia. with adewuate pain control. However patient had \npruritis most likelly related to Dilaudid and was started on \nFamotidine and Benadryl. Patient was passing flatus and was \nstarted on clear liquids. He had ___ episodes of loose bowel \nmovements overnight. On postoperative day 2 patient was febrile \nto 102.3 and diaphoretic. Thus had an abdominal/ pelvic CT scan \nwhich showed no evidence of abcess or leak. On postoperative day \n3 was afebrile and continued to pass flatus with diarrhea. He \nhad C. diff test completed 3 consequetive days. On postoperative \nday 4 was feelibng better. On postoperative 5 had increased \nabdominal distension, nausea and vomitting and crampy abdominal \npain with oral intake. On postoperative day 6, he had loose \nstools and he had stool cultures. The diet was backed down to \nclear liquids due to persistent abdominal distension. His \nabdominal distension eventually decreased. The patient \ncomplained of abdominal cramping when he was sitting in the \nchair for long periods of time. Otherwise, the pain decreased \nwith ambulation. On the day of discharge, ___, he was switched \nfrom solumedrol to prednisone 10mg daily. He was asked to follow \nup with his gastroenterology physicians to adjust his dose of \nprednisoneasan outpatient.', 'medications_prescribed': ['oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) \nas needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', 'acyclovir 400 mg Tablet Sig: One (1) Tablet PO once a day. ', 'ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a \nday. ', 'lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for anxiety. ', 'prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) \nfor 1 months.\nDisp:*30 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 88, 'gender': 'F', 'symptoms': 'dystonia', 'medical_history': ['Aside from the dystonia, the patient has\nenjoyed excellent health. There is no history of hypertension,\ndiabetes, or other chronic medical illnesses.', 'His prior surgeries are the DBS procedure in ___ and\nremoval of the infected lead in ___.'], 'family_history': "There is no history of dystonia in the patient's\nfamily. His parents are both alive and dystonia free. He also\nhas two brothers and a sister who are unaffected.", 'present_illness': '___ is now a ___ young man with diffuse generalized \nmyoclonic dystonia in who had a bilateral deep brain stimulation \nsurgery approximately\n___ years ago. The patient enjoyed an excellent response to\nthat surgery and was able to enjoy a full college experience\nbecause of it. Unfortunately, approximately ___ years ago, he\ndeveloped an erosion of his scalp overlying the left DBS device,\nwhich prompted removal of the device. The plan at that time was\nto allow the scalp to heal and then to reimplant. However,\ninitially, ___ did well with only one device. He was able to\ncomplete his college education and his symptoms remained at bay. \n\nOf late, however, the patient feels that his symptoms have\nreturned and are getting worse. In addition, he feels that he \nis\neven worsening on the treated side. For this reason, he \npresents\nto be evaluated for surgery to reimplant the left-sided device.', 'medications': [{'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'QPM', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', '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': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '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 Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Triamterene-HCTZ (37.5/25)', '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': '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 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/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64.5', 'valuenum': 64.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '334', 'valuenum': 334.0, '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': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '27.5', 'valuenum': 27.5, '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': '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': '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': 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': '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': 'MANY.'}, {'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': 'SM .'}, {'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': '14', 'valuenum': 14.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': 'Cloudy.'}, {'value': 'YELLOW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCC.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', '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': '3.9', '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': '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': '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': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '358', 'valuenum': 358.0, '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': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.7', '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': '4.8', 'valuenum': 4.8, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 228.0, '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': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '___', 'valuenum': 5.0, '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': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'from ___ PHYSICAL EXAMINATION:\nGENERAL: Reveals a normally developed young man with obvious\nmyoclonic dystonia effecting the right side more so that the\nleft. He is alert and oriented to all spheres. His expressive\ninterceptive language functions are normal.\nVITAL SIGNS: He stands 5 feet 6 inches tall and weighs 122\npounds.\nHEENT: His pupils are equal and reactive to light. His\nextraocular movements are full. His face is symmetric. His\ntongue and palate are midline.\nNEUROLOGIC: Tone is essentially normal. He has obvious \ndystonic\ntremors consistent with his myoclonic dystonia that affect the\nright side worse than the left. Strength is ___. There is no\nupper extremity drift. He ambulates on a narrow base with some\nintorsion of the right foot. Sensory exam is grossly intact. \nCoordination is normal and toes are downgoing.\n\nOn the day of discharge ___', 'diagnoses': [{'icd_code': '82021', 'desc': 'Closed fracture of intertrochanteric section of neck of femur'}, {'icd_code': '5559', 'desc': 'Regional enteritis of unspecified site'}, {'icd_code': '78609', 'desc': 'Other respiratory abnormalities'}, {'icd_code': '27549', 'desc': 'Other disorders of calcium metabolism'}, {'icd_code': '71230', 'desc': 'Chondrocalcinosis, unspecified, site unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': 'E8842'}, {'icd_code': 'E8490', 'desc': 'Home accidents'}, {'icd_code': 'E0299', 'desc': 'Other activity'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': 'V6406', 'desc': 'Vaccination not carried out because of patient refusal'}], 'summary': '___ MRI Brain no Contrast post operative\nAppropriate lead placement of deep brain stimulator.\n\n___ 07:25AM GLUCOSE-71 UREA N-13 CREAT-1.2 SODIUM-145 \nPOTASSIUM-3.5 CHLORIDE-107 TOTAL CO2-26 ANION GAP-16\n___ 07:25AM estGFR-Using this\n___ 07:25AM CALCIUM-9.4 PHOSPHATE-3.6 MAGNESIUM-1.8\n___ 07:25AM WBC-8.9 RBC-4.09* HGB-11.8* HCT-35.3* MCV-86 \nMCH-28.8 MCHC-33.3 RDW-13.6\n___ 07:25AM PLT COUNT-335\n___ 07:25AM ___ PTT-33.4 ___\nThis is a ___ year old male with history of myclonic dystonia who \npresents today for stage 1 DBS on the left and battery change on \nthe right DBS at the right chest wall. His deep Brain Stimulator \nwas turned off prior to his MRIon ___ at approximately \n0800.\nThe patient had a post operative MRI to evaluate placement of \nthe left DBS that was consistent with proper lead placement. The \npatient tolerated the procedure well and was recovered in the \nPACU. \nAt the time of discharge on ___, POD #1, the patient \nwas doing well, afebrile with stable vital signs, tolerating a \nregular diet, ambulating, voiding without assistance, stable \nneuro exam and pain was well controlled. The patient was given \nwritten instructions concerning precautionary instructions and \nthe appropriate follow-up care. All questions were answered \nprior to discharge and the patient expressed readiness for \ndischarge.'}}
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{'final_diagnoses': ['myoclonic dystonia'], 'procedures': ['DBS stage 2 on LEFT', 'Right chest battery change for DBS'], 'visit_summary': 'This is a ___ year old male with history of myclonic dystonia who \npresents today for stage 1 DBS on the left and battery change on \nthe right DBS at the right chest wall. His deep Brain Stimulator \nwas turned off prior to his MRIon ___ at approximately \n0800.\nThe patient had a post operative MRI to evaluate placement of \nthe left DBS that was consistent with proper lead placement. The \npatient tolerated the procedure well and was recovered in the \nPACU. \nAt the time of discharge on ___, POD #1, the patient \nwas doing well, afebrile with stable vital signs, tolerating a \nregular diet, ambulating, voiding without assistance, stable \nneuro exam and pain was well controlled. The patient was given \nwritten instructions concerning precautionary instructions and \nthe appropriate follow-up care. All questions were answered \nprior to discharge and the patient expressed readiness for \ndischarge.', 'medications_prescribed': ['1. ClonazePAM 0.5 mg PO Q6H:PRN dystonic movements ', '2. Trihexyphenidyl 2 mg PO Q6H:PRN for tremors ', '3. Acetaminophen 325-650 mg PO Q6H:PRN pain/headache ', '4. Bisacodyl 10 mg PO/PR DAILY ', '5. Codeine Sulfate ___ mg PO Q4H:PRN pain headcahe \nRX *codeine sulfate 15 mg ___ tablet(s) by mouth every four (4) \nhours Disp #*60 Tablet Refills:*0', '6. Docusate Sodium 100 mg PO BID ', '7. Senna 1 TAB PO BID ']}
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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': 'hematuria', 'medical_history': ['Hemorrhoids s/p surgery about ___ years ago ', 'Type II Diabetes', 'Cataracts s/p surgery ', 'Hepatitis C exposure according to his labs, although he is not\naware of this diagnosis', 'metastatic castration resistant prostate cancer'], 'family_history': 'He has a brother ___ his ___ with similar urinary\nsymptoms, although it is unclear whether he has sought medical\nattention or has a diagnosis of prostate cancer, a sister who \nhad\nbreast cancer ___ her ___, now alive status post mastectomy ___\n___. Denies any other family history of malignancy', 'present_illness': '___ is a ___ year old male with\nmetastatic, castrate resistant prostate cancer (mets to bones,\nlungs) on Docetaxel (C2 D1 on ___, presenting with hematuria.\n\nHe reports that he was at his baseline state of health until\n___, when he noticed trouble urinating, and when he did urinate\nit was bloody. He also had lower abdominal pain. He went to ___ and had a Foley catheter placed and he had bladder\nirrigation done. Admission was recommended but patient preferred\nto return home with foley ___ place, with plan to follow up at\n___. \n\nOvernight ___ into ___ he was feeling well, emptying the\nfoley of urine, which did appear bloody, a few times overnight.\nHowever, the morning of admission ___ he had two episodes of \nall\nblood being ___ the foley, and it overflowed onto the ground. He\nreports that there was stool as well; his wife is adamant that\nthere was no stool ("I cleaned it, twice"). \n\n___ the ED, initial vitals were: 97.2 | 103 | 121/62 | 18 | 100%\nRA \n\nLabs were notable for: \n16.6 > 11.3/34.6 < 154\n PMNs 86.9\n\n___ 14.4, PTT 31.1, INR 1.3\n\nChem-10 within normal limits. \n\nUA with >182 RBC, WBC 3, few bacteria, 0 epis. \n\nUpon arrival he was hand irrigated for multiple large blood \nclots\nand CBI was initiated. \n\nA CT of the abdomen and pelvis with contrast showed the \nfollowing\non wet read:\n1. Interval progression of malignant invasion of the bladder\nwhich is the likely source of hematuria.\n2. Scattered intra-abdominal and pelvic implants, some new and\nothers increased ___ conspicuity as above, concerning for\nmetastatic disease progression.\n3. Stable retroperitoneal and pelvic lymphadenopathy, and \nosseous\nmetastatic disease.\n4. Findings suggestive of proctocolitis with prominent\nhemorrhoids.\n5. Redemonstration of right perianal fistula. Rim enhancing \nfluid\ncollection measuring up to 5.0 cm posterior to the rectum is \nseen\nwithin the region of previously described intersphincteric\nabscess, but was not clearly seen on the\nprevious study. This collection is also associated with a left\nperianal fistula. MRI of the pelvis is recommended to better\nassess fistulous disease.\n6. Intraluminal bladder air is presumably related to Foley\ncatheterization.\n\nColorectal surgery was consulted and recommended MRI of the\npelvis to better delineate anatomy, and with plan for drainage \nof\nlarge abscess.\n\nThe patient was given Ceftriaxone 1gm IV and metronidazole 500mg\nIV. \n\n- Vitals prior to transfer: 97.5 | 110 | 139/83 | 19 100% ra \n\nUpon arrival to the floor, the patient and his wife confirm the\nabove history. He requests that she help him translate.\nInitially, he wants to leave AMA prior to his admission because\nhe and his wife have been together for ___ years and he cannot\nsleep apart from her (he is ___ a shared room). They were very\npolite about this barrier. Ultimately they were agreeable to a\nrecliner chair next to his bed. \n\nNotably, he was recently treated for balinitis with fluconazole\n150 mg PO, clotrimazole 1% topical BID x1, and cephalexin 500 mg\nPO QID x7 days (subsequently tmp-smx for MRSA+), with \nimprovement\nsuch that he was able to retract his foreskin without pain. He \nis\nstill on topical clotrimazole. It has improved overall. \n\nHe has had a poor appetite for some time (only ate half a\nsandwich today) and also strains to stool every ___ days. No \npain\nwith defecation, brbpr or melena.', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Dextrose 50%', '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 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': '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin E', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': 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': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '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': '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': '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': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, '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': '88', 'valuenum': 88.0, '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': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.43', 'valuenum': 3.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}], 'exams': 'ADMISSION EXAM:\nVS: ___ 2122 Temp: 97.5 PO BP: 139/83 HR: 110 RR: 19 O2 \nsat:\n100% O2 delivery: ra \nGENERAL: Appears older than stated age and chronically ill but\nnontoxic, comfortable, no acute distress.\nHEENT: MMM, mild subconjunctival pallor, no scleral icterus,\nmoist mucous membranes. \nNECK: No concerning lymphadenopathy. \nCV: RRR\nPULM: Clear to auscultation with good air movement throughout \nand\nno adventitious sounds.\nABD: Soft, nontender, nondistended. \nGU: Foley draining yellow urine. Uncircumcised penis with \nnotable\nblood and clotting at the meatus, as well as what appears to be\nsome denuded/raw skin. Pain with retraction of foreskin. No\nspecific ulcers, chancres, vesicles. \nEXT: Warm, well-perfused, no edema\nSKIN: Multiple tattoos, many of which appear to be home-made. \nNEURO: Face grossly symmetric, moving all limbs with purpose\nagainst gravity. \nACCESS: PIV\n\nDISCHARGE EXAM:\nVS: ___ 1138 Temp: 98.3 PO BP: 107/56 HR: 92 RR: 18 O2 sat: \n99% O2 delivery: Ra \nGENERAL: Comfortable appearing\nHEENT: MMM, mild subconjunctival pallor, no scleral icterus,\nmoist mucous membranes. \nNECK: No concerning lymphadenopathy. \nCV: RRR\nPULM: Clear to auscultation with good air movement throughout \nand\nno adventitious sounds.\nABD: Soft, nontender, nondistended. \nGU: Foley draining yellow urine. Uncircumcised penis with \nnotable\nblood and clotting at the meatus, as well as what appears to be\nsome denuded/raw skin. Pain with retraction of foreskin. No\nspecific ulcers, chancres, vesicles. \nEXT: Warm, well-perfused, no edema\nSKIN: Multiple tattoos, many of which appear to be home-made. \nNEURO: Face grossly symmetric, ambulating normally\nACCESS: PIV', 'diagnoses': [{'icd_code': '9729', 'desc': 'Poisoning by other and unspecified agents primarily affecting the cardiovascular system'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': '9651', 'desc': 'Poisoning by salicylates'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '36900', 'desc': 'Profound impairment, both eyes, impairment level not further specified'}, {'icd_code': '2409', 'desc': 'Goiter, 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': 'E8583', 'desc': 'Accidental poisoning by agents primarily affecting cardiovascular system'}, {'icd_code': 'E8503', 'desc': 'Accidental poisoning by salicylates'}, {'icd_code': '78451', 'desc': 'Dysarthria'}], 'summary': 'ADMISSION LABS:\n\n___ 12:35PM BLOOD WBC-16.6* RBC-3.97* Hgb-11.3* Hct-34.6* \nMCV-87 MCH-28.5 MCHC-32.7 RDW-14.6 RDWSD-46.5* Plt ___\n___ 12:35PM BLOOD Neuts-86.9* Lymphs-6.8* Monos-4.1* \nEos-0.0* Baso-0.3 Im ___ AbsNeut-14.45* AbsLymp-1.13* \nAbsMono-0.68 AbsEos-0.00* AbsBaso-0.05\n___ 12:35PM BLOOD ___ PTT-31.1 ___\n___ 12:35PM BLOOD Glucose-131* UreaN-18 Creat-0.8 Na-138 \nK-4.2 Cl-101 HCO3-22 AnGap-15\n___ 12:35PM BLOOD ALT-10 AST-14 AlkPhos-96 TotBili-0.6\n___ 12:35PM BLOOD Albumin-3.8 Calcium-8.6 Phos-3.4 Mg-1.8\n\nDISCHARGE LABS:\n\n___ 05:58AM BLOOD WBC-8.5 RBC-3.49* Hgb-10.1* Hct-30.7* \nMCV-88 MCH-28.9 MCHC-32.9 RDW-14.6 RDWSD-46.5* Plt ___\n___ 05:58AM BLOOD UreaN-15 Creat-0.7\n\nOTHER IMPORTANT RESULTS:\n\nUrine cytology ___ pending\n\nMICRO:\n\nTime Taken Not Noted ___ Date/Time: ___ 2:59 pm\n URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n\n___ 12:53 pm SWAB LEFT SIDED FISTULA TRACK. \n\n GRAM STAIN (Final ___: \n 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 3+ ___ per 1000X FIELD): GRAM POSITIVE COCCI ___ \nPAIRS. \n ___ CLUSTERS. \n 3+ ___ per 1000X FIELD): GRAM POSITIVE COCCI ___ \nPAIRS. \n ___ CHAINS. \n 2+ ___ per 1000X FIELD): GRAM NEGATIVE ROD(S). \n\n WOUND CULTURE (Preliminary): RESULTS PENDING. \n\n ANAEROBIC CULTURE (Preliminary): \n\n___ 6:45 pm BLOOD CULTURE\n\n Blood Culture, Routine (Preliminary): \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. \n Isolated from only one set ___ the previous five days. \n SENSITIVITIES PERFORMED ON REQUEST..\n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI ___ PAIRS AND CLUSTERS. \n Reported to and read back by ___ AT \n2150 ON\n ___ AND ___ AT 2146 ON ___. \n\n Aerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI ___ PAIRS AND CLUSTERS. \n\nOther set of culture from ___ NGTD\n\nRepeat blood cultures ___ NGTD\n\nIMAGING:\n\nCT ABDOMEN/PELVIS WITH CONTRAST:\n1. Interval progression of malignant invasion of the bladder \nwhich is the\nlikely source of hematuria.\n2. Scattered intra-abdominal and pelvic implants, some new and \nothers\nincreased ___ conspicuity as above, concerning for metastatic \ndisease\nprogression.\n3. Stable retroperitoneal and pelvic lymphadenopathy, and \nosseous metastatic disease.\n4. Findings suggestive of proctocolitis with prominent \nhemorrhoids.\n5. Redemonstration of right perianal fistula. Rim enhancing \nfluid collection measuring up to 5.0 cm posterior to the rectum \nis seen within the region of previously described \nintersphincteric abscess, but was not clearly seen on the \nprevious study. This collection is also associated with a left \nperianal fistula. MRI of the pelvis is recommended to better \nassess fistulous disease.\n6. Intraluminal bladder air is presumably related to Foley \ncatheterization.\n\nMR PELVIS W & W/O CONTRAST:\n \n1. Trans sphincteric perianal fistula(s) at approximately the 6 \no\'clock position at the superior margin of the anal sphincter \nwith right and left branches exiting the right and left gluteal \nfolds. There is either one fistula with proximal branching or \ntwo separate fistulas arising within one millimeter of each \nother. The left fistula courses at least partially within the \nleft puborectalis musculature. An abscess along the dominant \nleft fistula tract measures up to 2.2 x 4.8 cm. \n2. Extensive metastatic disease includes infiltrative bladder\nlesions, osseous lesions, and lymphadenopathy.\nMr. ___ is a ___ y/o M with metastatic prostate cancer \npresenting with recurrent hematuria/obstruction and a perianal \nfistula w/ abscess.\n\n#PERIANAL FISTULAE (B/L):\n#POSTERIOR RECTAL ABCESS: \nOn admission noted to have perianal abscess measuring 5.0 cm, \n"within the region of previously described intersphincteric \nabscess," and is associated with left perianal fistula. He also \nhad leukocytosis with neutrophilic predominance. There is also \nevidence of proctocolitis on imaging. Her reports constipation \n(frequent straining, only passes stool every 2 to 3 days). MRI \npelvis confirmed perianal fistula either with branching or \npossibly two separate fistulae that are millimeters apart. \nColorectal surgery performed EUA, drainage of abscess and \nplacement ___ drain on ___. That evening post-op, \npatient\'s admission blood cultures returned positive for GPCs ___ \nboth aerobic and anaerobic bottle, therefore he was started on \nempiric IV vancomycin. Resulted as coag negative staph on ___, \nand after discussion with ID, decision that this was likely \ncontaminant, and discontinued vanco. Per surgery for abscess, \ntreated with 3 further days of Augmentin. Abscess culture \npending, gram stain w/ GPCs ___ clusters, GPCs ___ chains, and \nGNRs. Patient will follow up with CRS after discharge for \nconsideration of removal ___ drain.\n\n#HEMATURIA: \nLikely from known local invasion of his prostatic malignancy \ninto the bladder. Had recurrence w/ clot. Foley placed at \n___ on ___ for hematuria, got 3w irrigation. He was \nadvised to be admitted, however patient chose to leave ED \ninstead with Foley with close follow-up ___ ___ clinic. Upon \npresentation to our ED, Foley draining mostly clear urine with \nslight pink tinge. After discussion with patient\'s urologist, we \nremoved Foley and he voided well. Urology had requested CTU, \nhowever patient had just had CT w/ contrast of abdomen and per \nradiology not much more information could be gathered from CTU \nprotocol. Urine cytology sent, pending result at time of \ndischarge.\n\n#Balanitis: Had recent treatment for MRSA balanitis. This had \nimproved. Appears to have recurred upon admission. No phimosis. \nBloody appearance of foreskin may be from hematuria. Patient \nrefused mupirocin. Of note, his urologist had been suggesting \nthat if this recurs, plan would be for circumcision. Scheduled \nfor outpatient urology follow up on discharge.\n\n#ANEMIA: Normal H&H ___ ___, hemoglobin 11.3 today. Could \nbe from hematuria, though 3 units of blood loss is quite \nsignificant. Will obtain iron studies and reticulocyte count. \nLow concern for sepsis at this time based on bili. Patient \nappears to be somewhat iron deficient, plus likely concomitant \nanemia of inflammation.'}}
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{'final_diagnoses': ['Perianal fistula', 'Abscess', 'Hematuria', 'Metastatic prostate cancer'], 'procedures': ['eua', 'drainage of abscess', 'placement ___ drain ___'], 'visit_summary': 'Mr. ___ is a ___ y/o M with metastatic prostate cancer \npresenting with recurrent hematuria/obstruction and a perianal \nfistula w/ abscess.\n\n#PERIANAL FISTULAE (B/L):\n#POSTERIOR RECTAL ABCESS: \nOn admission noted to have perianal abscess measuring 5.0 cm, \n"within the region of previously described intersphincteric \nabscess," and is associated with left perianal fistula. He also \nhad leukocytosis with neutrophilic predominance. There is also \nevidence of proctocolitis on imaging. Her reports constipation \n(frequent straining, only passes stool every 2 to 3 days). MRI \npelvis confirmed perianal fistula either with branching or \npossibly two separate fistulae that are millimeters apart. \nColorectal surgery performed EUA, drainage of abscess and \nplacement ___ drain on ___. That evening post-op, \npatient\'s admission blood cultures returned positive for GPCs ___ \nboth aerobic and anaerobic bottle, therefore he was started on \nempiric IV vancomycin. Resulted as coag negative staph on ___, \nand after discussion with ID, decision that this was likely \ncontaminant, and discontinued vanco. Per surgery for abscess, \ntreated with 3 further days of Augmentin. Abscess culture \npending, gram stain w/ GPCs ___ clusters, GPCs ___ chains, and \nGNRs. Patient will follow up with CRS after discharge for \nconsideration of removal ___ drain.\n\n#HEMATURIA: \nLikely from known local invasion of his prostatic malignancy \ninto the bladder. Had recurrence w/ clot. Foley placed at \n___ on ___ for hematuria, got 3w irrigation. He was \nadvised to be admitted, however patient chose to leave ED \ninstead with Foley with close follow-up ___ ___ clinic. Upon \npresentation to our ED, Foley draining mostly clear urine with \nslight pink tinge. After discussion with patient\'s urologist, we \nremoved Foley and he voided well. Urology had requested CTU, \nhowever patient had just had CT w/ contrast of abdomen and per \nradiology not much more information could be gathered from CTU \nprotocol. Urine cytology sent, pending result at time of \ndischarge.\n\n#Balanitis: Had recent treatment for MRSA balanitis. This had \nimproved. Appears to have recurred upon admission. No phimosis. \nBloody appearance of foreskin may be from hematuria. Patient \nrefused mupirocin. Of note, his urologist had been suggesting \nthat if this recurs, plan would be for circumcision. Scheduled \nfor outpatient urology follow up on discharge.\n\n#ANEMIA: Normal H&H ___ ___, hemoglobin 11.3 today. Could \nbe from hematuria, though 3 units of blood loss is quite \nsignificant. Will obtain iron studies and reticulocyte count. \nLow concern for sepsis at this time based on bili. Patient \nappears to be somewhat iron deficient, plus likely concomitant \nanemia of inflammation.', 'medications_prescribed': ['Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 3 Days', 'Clotrimazole Cream 1 Appl TP BID apply to penis', 'Denosumab (Xgeva) 120 mg SC EVERY 4 WEEKS', 'Leuprolide Acetate 22.5 mg IM EVERY 3 MONTHS', 'Ondansetron 8 mg PO Q8H:PRN Nausea/Vomiting - First Line', 'Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - Second Line']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 82, 'gender': 'F', 'symptoms': 'Oxaliplatin desensitization', 'medical_history': ['PAST ONCOLOGIC HISTORY:\nAmpullary cancer stage IIB (T3N1M0), now metatstatic\n- ___ Developed malaise, low-grade fever and dark urine. He\nwas seen by his PCP who found elevated transaminases and T bili. \n\nAn ultrasound showed intrahepatic and extrahepatic ductal\ndilation with biliary sludge. \n- ___ ERCP at ___ revealed a fungating ampullary mass and\na biliary stent was placed. Biopsy showed poorly differentiated\ncarcinoma with features of adenocarcinoma and neuroendocrine\ncarcinoma. Staging CT showed no evidence of distant metastatic\ndisease. \n- ___ Underwent pylorus-sparing radical\npancreaticoduodenectomy with feeding tube placement. Pathology\nfrom this resection demonstrated poorly differentiated ampullary\nadenocarcinoma with neuroendocrine features in the setting of\nhigh-grade dysplasia. The tumor was locally invasive at the\npancreas and ___ lymph nodes were positive. Taken together,\nthis is a T3N1M0 cancer. His margins were widely negative. \n- ___ C1D1 gemcitabine 1000 mg/m2 D1,8,15\n- ___ C2D1 gemcitabine 1000 mg/m2 D1,8,15\n- ___ C3D1 gemcitabine 1000 mg/m2 D1,8,15\n- ___ C4D1 gemcitabine 1000 mg/m2 D1,8,15\n- ___ CT torso showed multiple new liver mets\n- ___ ___ guided biopsy of a liver lesion confirmed\nmetastatic adenocarcinoma with some neuroendocrine features as\nwith his intial presentation. \n- ___ Second opinions at ___ and ___\n- ___ C1D1 FOLFOX6\n- ___ C2D1 FOLFOX6\n- ___ CT torso with stable disease\n- ___ C2D15 modified FOLFOX (ci5FU 1800 mg/m2, oxaliplatin\n65 mg/m2) due to mucositis and neuropathy\n- ___ C3D1 modified FOLFOX (ci5FU 1800 mg/m2, oxaliplatin \n65\nmg/m2) delayed for patient travel\n- ___ C4D1 modified FOLFOX (ci5FU 1800 mg/m2, oxaliplatin \n65\nmg/m2)\n- ___ C4D15 dose of chemo given after 1 week delay per\npatient preference\n- ___ CT torso showed decrease in size of all previously\nseen liver lesions with no new liver metastases identified.\nUnchanged soft tissue density of the central mesentery and\nsurrounding the SMA SMV, which is likely postsurgical. \n- ___ C5D1 modified FOLFOX (ci5FU 1800 mg/m2, oxaliplatin \n65\nmg/m2)\n- ___ Dose 1 modified de Gramont (ci5FU 1800 mg/m2) reduced\nfor mucositis, oxali removed from FOLFOX for neuropathy\n- ___ Dose 2 modified de Gramont (ci5FU 1800 mg/m2) \n- ___ Dose 3 modified de Gramont (ci5FU 1800 mg/m2)\n- ___ MR liver showed previously seen numerous liver\nmetastases are significantly decreased in size compared to prior\nMRI from ___ and similar appearance to the CT abdomen\npelvis from ___. No new metastatic lesions are seen. CT\nchest ___. \n- ___ Dose 4 modified de Gramont (ci5FU 1800 mg/m2) delayed\nper patient preference\n- ___ Dose 5 dose modified de Gramont (ci5FU 1800 mg/m2)\ndelayed per patient preference\n- ___ Dose 6 modified de Gramont (ci5FU 1800 mg/m2),\nswitching to Q21 day dosing per patient preference\n- ___ Dose 7 modified de Gramont (ci5FU 1800 mg/m2)\n- ___ Dose 8 modified de Gramont (ci5FU 1800 mg/m2)\n- ___ CT torso showed further reduction in metastatic\ndisease\n- ___ CT chest and MR abdomen showed no obvious progressive\ndisease\n- ___ CT chest and MR abdomen showed some nonspecific\npulmonary nodules but otherwise ___\n- ___ CT chest ___, MR abdomen showed recurrent liver \nmets\n- ___ MRI liver shows progressive disease in liver\n- ___ C9D1 modified de Gramont (ci5FU 1800 mg/m2)\n- ___ C10D1 modified de Gramont (ci5FU 1800 mg/m2)\n- ___ MR abdomen showed significant decrease in liver\nmets. CT chest showed possible aspiration\n- ___ modified de Gramont (ci5FU 1800 mg/m2)\n- ___ modified de Gramont (ci5FU 1800 mg/m2)\n- ___ modified de Gramont (ci5FU 1800 mg/m2)\n- ___ MR abdomen and CT chest showed significant \ntreatment\neffect\n- Received de Gramont regimen while in\n- ___ MR abdomen shows significant increase in size and\nnumber of liver metastasis, predominantly in the left lobe, CT\nchest ___\n- ___ C1D1 FOLFOX6 (oxali 65 mg/m2, ciFU 1800 mg/m2)\n- ___ Tested positive for oxaliplatin allergy \n- ___ C1D1 Irinotecan 180mg/m2 D1 and D15\n- ___ CT chest and MR abdomen showed good response to\ntherapy\n- ___ C2D1 Irinotecan 180mg/m2 D1 and D15\n- ___ Admitted with fevers and RUQ pain. Found to have\nprogressive disease and cholangitis on MRCP. ERCP negative for\nstricture.\n- ___ C2D1 FOLFOX (oxali 65 mg/m2, ciFU 1800 mg/m2) with \n3\nbag oxaliplatin desensitization\n- ___ C3D1 FOLFOX (oxali 65 mg/m2, ciFU 1800 mg/m2) with \n3\nbag oxaliplatin desensitization\n- ___ CT chest ___, MRI abdomen shows decrease in liver\nmets\n- ___ C4D1 FOLFOX (oxali 65 mg/m2, ciFU 1800 mg/m2) with \n3\nbag oxaliplatin desensitization\n- ___ C5D1 FOLFOX (oxali 65 mg/m2, ciFU 1800 mg/m2) with \n3\nbag oxaliplatin desensitization\n- ___ CT chest ___, MRI abdomen shows decrease in size of\nliver mets\n- ___ CT chest ___, MRI abdomen/pelvis shows increase in\nsize and number of liver mets', 'OTHER PAST MEDICAL HISTORY: \n- Constipation\n- GERD\n- Pancreatic Insufficiency\n- Mucosal Ulcers with Chemotherapy'], 'family_history': 'Mother with gastric cancer.', 'present_illness': '___ is a ___ year old man with metastatic ampullary\ncancer who is admitted for planned oxaliplatin desensitization \nas\npart of palliative FOLFOX.\n\nOn admission, patient generally feels well. However, on direct\nquestioning he does note occaisional chills at home. He also\nreports developing some intermittent right sided chest and back\npain for a few hours after doing pushups. No known fevers at \nhome\nand no current chest pain. He also denies any recent URTI. No\ncough, no SOB. No N/V/D. No leg pain or swelling. No rashes.\n\nREVIEW OF SYSTEMS: \nA complete 10-point review of systems was performed and was\nnegative unless otherwise noted in the HPI.', 'medications': [{'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Linezolid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY16', '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': 'Atorvastatin', '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': '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': 'Ranitidine', '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': 'Paricalcitol', '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': 'LUNCH', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Linezolid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H: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': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', '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': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Paricalcitol', '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Linezolid', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Paricalcitol', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Paricalcitol', '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': 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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyanocobalamin', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Nephrocaps', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': '1000', 'valuenum': 1000.0, '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': 'LG.'}, {'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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.016', 'valuenum': 1.016, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '434', 'valuenum': 434.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 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'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 301.0, 'valueuom': 'mg/dL', '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': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, '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': '50', 'valuenum': 50.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 54.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '68', 'valuenum': 68.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', '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': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '33.9', 'valuenum': 33.9, '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '___', 'valuenum': 133.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, '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': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91.6', 'valuenum': 91.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, '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': '13.9', 'valuenum': 13.9, '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': 4.2, '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}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.7,. Estimated GFR = 12 if non African-American (mL/min/1.73 m2). Estimated GFR = 14 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': 166.0, 'valueuom': 'mg/dL', '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': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 76.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.0', 'valuenum': 53.0, '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': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 222.0, 'valueuom': 'mg/dL', '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': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80.5', 'valuenum': 80.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.24', 'valuenum': 3.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM: \nVS: T 99.2 HR 112 BP 121/74 RR 18 SAT 99% O2 on RA\nGENERAL: Pleasant, well appearing, sitting up in bed in NAD\nEYES: Anicteric sclerea, PERLL, EOMI; \nENT: Oropharynx clear without lesion, JVD not elevated \nCARDIOVASCULAR: Slightly tachycardic rate and regular rhythm, no\nmurmurs, rubs, or gallops; 2+ radial pulses\nRESPIRATORY: Appears in no respiratory distress, clear to\nauscultation bilaterally, no crackles, wheezes, or rhonchi\nGASTROINTESTINAL: Normal bowel sounds; nondistended; soft,\nnontender without rebound or guarding\nMUSKULOSKELATAL: Warm, well perfused extremities without lower\nextremity edema; Normal bulk \nNEURO: Alert, oriented, CN III-XII intact, motor and sensory\nfunction grossly intact\nSKIN: No significant rashes\nLYMPHATIC: No cervical, supraclavicular, submandibular\nlymphadenopathy. No significant ecchymoses', 'diagnoses': [{'icd_code': '25012', 'desc': 'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled'}, {'icd_code': '42823', 'desc': 'Acute on chronic systolic heart failure'}, {'icd_code': '5856', 'desc': 'End stage renal disease'}, {'icd_code': '40391', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '25042', 'desc': 'Diabetes with renal manifestations, type II or unspecified type, uncontrolled'}, {'icd_code': 'V4511', 'desc': 'Renal dialysis status'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '04104', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '61801', 'desc': 'Cystocele, midline'}, {'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '3970', 'desc': 'Diseases of tricuspid valve'}], 'summary': "ADMISSION LABS\n\n___ 07:54AM BLOOD WBC-10.6*# RBC-4.44* Hgb-13.3* Hct-39.4* \nMCV-89 MCH-30.0 MCHC-33.8 RDW-12.2 RDWSD-39.4 Plt ___\n___ 07:54AM BLOOD Neuts-82.5* Lymphs-8.0* Monos-9.0 \nEos-0.0* Baso-0.2 Im ___ AbsNeut-8.77*# AbsLymp-0.85* \nAbsMono-0.96* AbsEos-0.00* AbsBaso-0.02\n___ 07:54AM BLOOD Glucose-123* UreaN-19 Creat-0.9 Na-136 \nK-4.3 Cl-98 HCO3-25 AnGap-13\n___ 07:54AM BLOOD ALT-156* AST-141* LD(LDH)-446* \nAlkPhos-471* TotBili-1.1\n___ 07:54AM BLOOD Calcium-8.9 Phos-1.7* Mg-1.9\nPRINCIPLE REASON FOR ADMISISON:\n___ is a ___ year old man with metastatic ampullary \ncancer who is admitted for planned oxaliplatin desensitization \nas part of palliative FOLFOX.\n\n# Tachycardia\n# Low grade temperature: Mild T of 99.2 on arrival with HR in \nthe\n110's. Patient otherwise well appearing. Bolused 500cc NS with\ngood effect. CXR and UA not indicative of infection. Could\nconsider PE, but patient without s/s of DVT. Discussed with Dr.\n___ elected to proceed with desensitization protocol. \nUrine culture is still pending at discharge.\n\n# Oxaliplatin hypersensitivity: Premedicated with 20mg \ncetirizine, 25mg IV Benadryl, 40mg famotidine, dexamethasone \n12mg IV, 10mg singular, 150mg fosaprepitant, and 100mg \nsolumedrol prior to bag 3. He then underwent 3 bag oxaliplatin \ndesensitization per OMS protocol\n\nHe developed some flushing and diaphoresis during bag #2 of \nprotocol. Paused infusion and gave additional 25mg IV Benadryl. \nSymptoms resolved and he tolerated the remainder of the infusion \nwithout event.\n\n# Transamintis: Likely from recurrent metstatic ampullary cancer \nnoted on recent MRI. Treating cancer as above. Will continue to \nmonitor as outpatient.\n\n# Chemotherapy induced mucositis: Mouth currently clear, but \npatient requesting nystatin on discharge as he frequently gets \nmucositis. He also has magic mouthwash at home.\n\n# Metastatic ampullary cancer: Treating with palliative intent.\nHas most recently been on treatment break, but increase in tumor\nburden noted with increasing symptoms. Plan is to resume FOLFOX\nwith oxali desens, as above. There is some thought of pursuing \nY90 local\ntreatment, as well. He will follow up in ___ clinic on \n___. \n\n# GERD: Cont pantoprazole\n\nTRANSITIONAL ISSUES:\n- Follow up in clinic on ___ for remainder of FOLFOX\n- ___ urine culture sent on admission given low grade \ntemperatures"}}
|
{'final_diagnoses': ['# Encounter for chemotherapy', '# Oxaliplatin hypersensitivity', '# Metastatic ampullary cancer'], 'procedures': ['None'], 'visit_summary': "PRINCIPLE REASON FOR ADMISISON:\n___ is a ___ year old man with metastatic ampullary \ncancer who is admitted for planned oxaliplatin desensitization \nas part of palliative FOLFOX.\n\n# Tachycardia\n# Low grade temperature: Mild T of 99.2 on arrival with HR in \nthe\n110's. Patient otherwise well appearing. Bolused 500cc NS with\ngood effect. CXR and UA not indicative of infection. Could\nconsider PE, but patient without s/s of DVT. Discussed with Dr.\n___ elected to proceed with desensitization protocol. \nUrine culture is still pending at discharge.\n\n# Oxaliplatin hypersensitivity: Premedicated with 20mg \ncetirizine, 25mg IV Benadryl, 40mg famotidine, dexamethasone \n12mg IV, 10mg singular, 150mg fosaprepitant, and 100mg \nsolumedrol prior to bag 3. He then underwent 3 bag oxaliplatin \ndesensitization per OMS protocol\n\nHe developed some flushing and diaphoresis during bag #2 of \nprotocol. Paused infusion and gave additional 25mg IV Benadryl. \nSymptoms resolved and he tolerated the remainder of the infusion \nwithout event.\n\n# Transamintis: Likely from recurrent metstatic ampullary cancer \nnoted on recent MRI. Treating cancer as above. Will continue to \nmonitor as outpatient.\n\n# Chemotherapy induced mucositis: Mouth currently clear, but \npatient requesting nystatin on discharge as he frequently gets \nmucositis. He also has magic mouthwash at home.\n\n# Metastatic ampullary cancer: Treating with palliative intent.\nHas most recently been on treatment break, but increase in tumor\nburden noted with increasing symptoms. Plan is to resume FOLFOX\nwith oxali desens, as above. There is some thought of pursuing \nY90 local\ntreatment, as well. He will follow up in ___ clinic on \n___. \n\n# GERD: Cont pantoprazole\n\nTRANSITIONAL ISSUES:\n- Follow up in clinic on ___ for remainder of FOLFOX\n- ___ urine culture sent on admission given low grade \ntemperatures", 'medications_prescribed': ['1. Acyclovir Ointment 5% 5 % topical QID Cold sores ', '2. Fish Oil (Omega 3) 1000 mg PO DAILY ', '3. LORazepam 0.5 mg PO Q8H:PRN spasm, anxiety ', '4. Maalox/Diphenhydramine/Lidocaine 15 mL PO QID:PRN mouth pain ', '5. Nystatin Oral Suspension 5 mL PO TID:PRN mouth sores \nRX *nystatin 100,000 unit/mL 5 mL by mouth four times a day \nRefills:*0 ', '6. Pantoprazole 40 mg PO Q24H ', '7. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting ', '8. Tumersaid (___) ___ \nmg oral Q24H ', '9. Zenpep (lipase-protease-amylase) 25,000-85,000- 136,000 unit \noral QIDACHS ']}
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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': 'kidney offer', 'medical_history': ['PMH: HTN, hypercholesterolemia,h/0 chickenpox with bad pna \nrequiring intubation and prolonged ICU stay in ___, ESRD \nsecondary to questionable HTN, currently on peritoneal dialysis \nsince ___. Enlarged prostate'], 'family_history': 'Mother deceased from asthma. Father deceased at age ___ from \ncolon cancer. 8 siblings; 2 oldest deceased, one was shot in \n___ and the other had cancer. Rest of them are alive. No \nchildren.', 'present_illness': '___ M with ESRD secondary to HTN on PD since ___. Completed \nrenal transplant workup and presents now for potential renal \ntransplant from high risk donor. Does one exchange with cycler \nduring the day then 3 cycles of PD via cycler at night. Dry \nweight is 116-117 lbs. He voids sm amts frequently for ~8oz per \nday. H/o Prostate enlargement.Recently burning when initiating \nstream. Burning stops during void. He has been in usual state of \nhealth. Reports recently being started on Lomotil for diarrhea \nthat has been worked up as an outpatient. Diarrhea x ___ year. He \nalso has lactose intolerance. He states that the dialysate may \nbe triggering his diarrhea. Denies fevers, chills, cp/sob, \nnausea,\nvomiting, abdominal pain, and dysuria.', 'medications': [{'medication': 'Ketoconazole Shampoo', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Triamcinolone Acetonide 0.1% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'amLODIPine', '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': '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Clindamycin', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketoconazole Shampoo', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': '3X/WEEK', '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': 'Gemfibrozil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin (Regular) for Hyperkalemia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Triamcinolone Acetonide 0.1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', '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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE:STAT', '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}]}, 'clinical_findings': {'labs': [{'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 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'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': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.8', 'valuenum': 51.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 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'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, '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': '30', 'valuenum': 30.0, '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': 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'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.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '383', 'valuenum': 383.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/mg', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': 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{'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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 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'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 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'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.43', 'valuenum': 4.43, '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': '50.5', 'valuenum': 50.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '98', 'valuenum': 98.0, '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': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.3', 'valuenum': 51.3, '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': '31.2', 'valuenum': 31.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '22', 'valuenum': 22.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, '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': '31.3', 'valuenum': 31.3, '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': '213', 'valuenum': 213.0, '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': '3.64', 'valuenum': 3.64, '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': '52.6', 'valuenum': 52.6, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', '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': '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': 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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, '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': '59', 'valuenum': 59.0, '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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.1, . estimated GFR (eGFR) is likely between 19 and 23 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': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, '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': '38.9', 'valuenum': 38.9, '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '52.2', 'valuenum': 52.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Specimen not Hemolyzed.'}, {'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': '50', 'valuenum': 50.0, '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': '36.2', 'valuenum': 36.2, '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': '31.7', 'valuenum': 31.7, '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': '100', 'valuenum': 100.0, '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.9', 'valuenum': 52.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.1', 'valuenum': 54.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 6.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Specimen not Hemolyzed.'}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, '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': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.60', 'valuenum': 3.6, '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': '54.9', 'valuenum': 54.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Specimen not Hemolyzed.'}, {'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': '49', 'valuenum': 49.0, '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': '5.9', 'valuenum': 5.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, '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': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. QNS TO CHECK FOR HEMOLYSIS.'}, {'value': '___', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '___', 'valuenum': 5.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP.'}, {'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': '5.5', 'valuenum': 5.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, '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': '5.5', 'valuenum': 5.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'PE: 95.8 hr 62 sl irreg 183/105 rr 16 O2RA 95% Wt 53.9kg\nwith 2 L dwell(Height 5\'6")\nA&O, NAD\nanicteric sclerae, mmm, pharynx wnl\n2+carotids, no bruits, no LAD\nLungs bibasilar rales\nCor sl irreg, no murmur, rate 72\nabd +bowel sounds, soft, non-tender, non-distended, PD fluid\nbeing drained out. PD catheter site w dry gauze dressing. no\nredness/drainage\next 2+ dps bilaterally, warm\nvasc 2+ right femoral, 1+left femoral', 'diagnoses': [{'icd_code': 'L03116', 'desc': 'Cellulitis of left lower limb'}, {'icd_code': 'N184', 'desc': 'Chronic kidney disease, stage 4 (severe)'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'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': 'T368X5A', 'desc': 'Adverse effect of other systemic antibiotics, initial encounter'}, {'icd_code': 'E875', 'desc': 'Hyperkalemia'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'B349', 'desc': 'Viral infection, unspecified'}, {'icd_code': 'L42', 'desc': 'Pityriasis rosea'}, {'icd_code': 'L821', 'desc': 'Other seborrheic keratosis'}, {'icd_code': 'L743', 'desc': 'Miliaria, unspecified'}, {'icd_code': 'I872', 'desc': 'Venous insufficiency (chronic) (peripheral)'}, {'icd_code': 'B353', 'desc': 'Tinea pedis'}], 'summary': '___ 10:50AM WBC-7.0 RBC-5.67 HGB-12.9* HCT-40.8 MCV-72* \nMCH-22.7* MCHC-31.6 RDW-15.5\n___ 10:50AM PLT COUNT-262\n___ 10:50AM ___ PTT-28.1 ___\n___ 10:50AM ALT(SGPT)-22 AST(SGOT)-31 LD(LDH)-187 ALK \nPHOS-161* TOT BILI-0.5\n___ 10:50AM ALBUMIN-4.5 CALCIUM-10.4* PHOSPHATE-3.9 \nMAGNESIUM-2.3\n___ 10:50AM GLUCOSE-87 UREA N-43* CREAT-8.9*# SODIUM-142 \nPOTASSIUM-3.8 CHLORIDE-96 TOTAL CO2-31 ANION GAP-19\nOn ___, patient was admitted with a kidney offer. He \nunderwent a deceased donor renal transplant into his right iliac \nfossa. The kidney graft had 2 renal arteries, due to an upper \npole branch that was anastomosed to a small opening that was \nmade in the upper portion of the proximal renal artery and then \nanastomosed to the external iliac artery. JP drain was placed. \nPlease refer to operative note for details. He received \ninduction immunosuppression that consisted of ATG 100mg, \nCellcept and \nSolumedrol. \n\nPostop, urine output was excellent averaging 4 liters/day for \nthe first 4 days with adequate IV fluid replacements. IV fluid \nwere decreased and urine output decreased to ___ liters per day. \nCreatinine decreased daily to 1.4 by postop day 7. \n\nPatient had a Hct drop on postop day 3 to 21.5. He was \ntransfused with 2 units of PRBC. Hct increased to 25.9. An \nultrasound was performed showing an intact transplant kidney, \nwith high normal resistive indices, but no definite \nperinephritic hematoma. A CT showed evidence for discrete \ncollection adjacent to the transplant itself, but small \nhematomas involving the right psoas muscle and right lateral \npelvic wall. His INR was found to be 2.8 without a clear cause. \nHe was given vitamin K and FFP and INR decreased to 1.0. He \nreceived 2 more units of RBCs on POD4, but his Hct remained \nstable >30 during the rest of his postoperative course.\n\nGlucoses, amylase and lipase were stable. Diet was advanced and \ntolerated. Incision had significant ecchymosis after his Hct \ndrop, but had no erythema, induration, drainage or other signs \nof infection. \n\nBy POD7 he was doing well, tolerating a regular diet, ambulating \nindependently, with no signs of further hematoma. He receieved a \ntotal of 3 doses of ATG (75 mg each). Cellcept was well \ntolerated and solumedrol tapered off. Prograf was adjusted per \ntrough levels. His drain was pulled on POD6. He was started on \nnorvasc for hypertension up to 170s/80s. He was discharged home \nwith ___ services for med teaching, wound check and BP checks.'}}
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{'final_diagnoses': ['ESRD now s/p kidney transplant'], 'procedures': ['___: Deceased donor renal transplant'], 'visit_summary': 'On ___, patient was admitted with a kidney offer. He \nunderwent a deceased donor renal transplant into his right iliac \nfossa. The kidney graft had 2 renal arteries, due to an upper \npole branch that was anastomosed to a small opening that was \nmade in the upper portion of the proximal renal artery and then \nanastomosed to the external iliac artery. JP drain was placed. \nPlease refer to operative note for details. He received \ninduction immunosuppression that consisted of ATG 100mg, \nCellcept and \nSolumedrol. \n\nPostop, urine output was excellent averaging 4 liters/day for \nthe first 4 days with adequate IV fluid replacements. IV fluid \nwere decreased and urine output decreased to ___ liters per day. \nCreatinine decreased daily to 1.4 by postop day 7. \n\nPatient had a Hct drop on postop day 3 to 21.5. He was \ntransfused with 2 units of PRBC. Hct increased to 25.9. An \nultrasound was performed showing an intact transplant kidney, \nwith high normal resistive indices, but no definite \nperinephritic hematoma. A CT showed evidence for discrete \ncollection adjacent to the transplant itself, but small \nhematomas involving the right psoas muscle and right lateral \npelvic wall. His INR was found to be 2.8 without a clear cause. \nHe was given vitamin K and FFP and INR decreased to 1.0. He \nreceived 2 more units of RBCs on POD4, but his Hct remained \nstable >30 during the rest of his postoperative course.\n\nGlucoses, amylase and lipase were stable. Diet was advanced and \ntolerated. Incision had significant ecchymosis after his Hct \ndrop, but had no erythema, induration, drainage or other signs \nof infection. \n\nBy POD7 he was doing well, tolerating a regular diet, ambulating \nindependently, with no signs of further hematoma. He receieved a \ntotal of 3 doses of ATG (75 mg each). Cellcept was well \ntolerated and solumedrol tapered off. Prograf was adjusted per \ntrough levels. His drain was pulled on POD6. He was started on \nnorvasc for hypertension up to 170s/80s. He was discharged home \nwith ___ services for med teaching, wound check and BP checks.', 'medications_prescribed': ['1. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) \nTablet PO DAILY (Daily).', '2. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day).', '3. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO \nBID (2 times a day).', '4. valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '5. famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) \nCapsule, Ext Release 24 hr PO HS (at bedtime).', '7. diphenoxylate-atropine 2.5-0.025 mg Tablet Sig: One (1) \nTablet PO BID (2 times a day).', '8. oxycodone 5 mg Tablet Sig: Thirty (30) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', '9. metoprolol tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID \n(2 times a day).', '10. tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every \n12 hours).', '11. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO twice a day.', '12. Norvasc 5 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 30, 'gender': 'F', 'symptoms': 'Intermittent claudication of the\nleft lower extremity.', 'medical_history': ['carotid stenosis', 'claudication', 'HTN', 'Osteoarthritis', 'RCEA 03', '___ diagnostic angio'], 'family_history': 'n/c', 'present_illness': 'This ___ lady has severe disabling\nintermittent claudication of her left leg. Arteriography\nshowed essentially occlusion of her common carotid artery\nwith plaque obstructing the origins of both the superficial\nand deep femoral arteries. The superficial femoral artery was\npatent to the level of the knee with the popliteal artery\noccluded, but good collaterals filled the anterior tibial and\nperoneal artery distally.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], '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:\nrle - palp fem, pop, dop pt, dop dp\nlle - palp fem, pop, dop pt, dop dp', 'diagnoses': [{'icd_code': '30928', 'desc': 'Adjustment disorder with mixed anxiety and depressed mood'}], 'summary': '___ 06:10AM BLOOD Hct-33.5* Plt ___\n___ 03:49PM BLOOD ___ PTT-31.4 ___\n___ 06:10AM BLOOD UreaN-19 Creat-0.8 Na-139 K-3.9\n___ 04:12AM BLOOD ALT-14 AST-16 AlkPhos-64 TotBili-0.7\n___ 04:12AM BLOOD Calcium-8.0* Phos-3.8 Mg-2.3\nMr. ___ was admitted on ___ with intermittent \nclaudication. He agreed to have an elective surgery. \nPre-operatively, he was consented. A CXR, EKG, UA, CBC, \nElectrolytes, T/S - were obtained, all other preparations were \nmade.\n \nIt was decided that she would undergo a:\n\nLeft common proximal superficial femoral and deep\nfemoral artery endarterectomy and saphenous vein patch\nangioplasty.\n\nHe was prepped, and brought down to the operating room for \nsurgery. Intra-operatively, he was closely monitored and \nremained hemodynamically stable. He tolerated the procedure well \nwithout any difficulty or complication.\n \nPost-operatively, he was extubated and transferred to the PACU \nfor further stabilization and monitoring. \n \nHe was then transferred to the VICU for further recovery. While \nin the VICU he received monitored care. When stable he was \ndelined. His diet was advanced. A ___ consult was obtained. When \nhe was stabilized from the acute setting of post operative care, \nhe was transferred to floor status \n \nOn the floor, he remained hemodynamically stable with his pain \ncontrolled. He progressed with physical therapy to improve his \nstrength and mobility. He continues to make steady progress \nwithout any incidents. He was discharged home in stable \ncondition.'}}
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{'final_diagnoses': ['Intermittent claudication of the left lower extremity.'], 'procedures': ['Left common proximal superficial femoral and deep\nfemoral artery endarterectomy and saphenous vein patch\nangioplasty.'], 'visit_summary': 'Mr. ___ was admitted on ___ with intermittent \nclaudication. He agreed to have an elective surgery. \nPre-operatively, he was consented. A CXR, EKG, UA, CBC, \nElectrolytes, T/S - were obtained, all other preparations were \nmade.\n \nIt was decided that she would undergo a:\n\nLeft common proximal superficial femoral and deep\nfemoral artery endarterectomy and saphenous vein patch\nangioplasty.\n\nHe was prepped, and brought down to the operating room for \nsurgery. Intra-operatively, he was closely monitored and \nremained hemodynamically stable. He tolerated the procedure well \nwithout any difficulty or complication.\n \nPost-operatively, he was extubated and transferred to the PACU \nfor further stabilization and monitoring. \n \nHe was then transferred to the VICU for further recovery. While \nin the VICU he received monitored care. When stable he was \ndelined. His diet was advanced. A ___ consult was obtained. When \nhe was stabilized from the acute setting of post operative care, \nhe was transferred to floor status \n \nOn the floor, he remained hemodynamically stable with his pain \ncontrolled. He progressed with physical therapy to improve his \nstrength and mobility. He continues to make steady progress \nwithout any incidents. He was discharged home in stable \ncondition.', 'medications_prescribed': ['Oxycodone 5 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) \nas needed for pain.\nDisp:*40 Tablet(s)* Refills:*0*', 'Atorvastatin 20 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily).', 'Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO \nDAILY (Daily).', 'Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO DAILY (Daily).', 'Moexipril 15 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Multivitamin Capsule Sig: One (1) Capsule 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': 81, 'gender': 'F', 'symptoms': 'shortness of breath', 'medical_history': ['Anemia', 'Aortic Stenosis', 'Atrial Fibrillation, Paroxysmal', 'Chronic Obstructive Pulmonary Disease', 'Congestive Heart Failure, chronic diastolic', 'Hidradenitis Suppurativa', 'Osteoarthritis', 'Ovarian Cyst', 'Pneumonia', 'Pulmonary Embolism', 'Schizophrenia', 'Thrombophlebitis', 'Deep vein thrombosis'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death.', 'present_illness': '___ year old woman with severe AS, pAF, hx of recent PE on \nEliquis, schizophrenia who presents as a direct admit for \npulmonary and AVR w/u. She was hospitalized at ___ on 2 \noccasions in ___. She was found to have severe aortic \nstenosis with an ___ of 1.0 cm2. She was in congestive heart \nfailure, which was difficult to treat immediately. She also had \natrial fibrillation and refused a cardioversion or \nanticoagulation. Her rate was controlled using amiodarone, \ndigoxin, and metoprolol. She was again hospitalized at ___ \n___. During this last hospitalization amiodarone was \nstopped as well as spironolactone. She becomes very frightened \nwhenever she is in the hospital which complicates decision \nmaking. \n\nToday she presented for a cardiac catheterization in an ongoing \nw/u for AVR. However, the procedure was not performed given the \ncardiologists wanted her optimized from a respiratory standpoint \nw/ her COPD. Therefore admitted for a pulm c/s for COPD \noptimization and ongoing w/u for AVR.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.009', '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': '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64.5', 'valuenum': 64.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, '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': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.19', 'valuenum': 4.19, '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': '19', 'valuenum': 19.0, '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': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.69', 'valuenum': 0.69, 'valueuom': 'U/mL', 'ref_range_lower': 0.3, 'ref_range_upper': 0.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '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': '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': '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', '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}], 'exams': 'Admission Exam \n=====================\nVITALS: 98.3 103 / 64 92 18 94 3LNC \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: Difficult to assess JVP given habitus \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RRR, normal S1, S2. ___ systolic murmur loudest in aortic \nwindow,\nLUNGS: kyphosis. Resp were unlabored, no accessory muscle use. \nBilateral crackles up to midthorax\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: stasis dermatitis bilateral extremities \nPULSES: Distal pulses palpable and symmetric \n\nDischarge Exam\nVitals: 98.7PO 93 / 57R Lying 92 18 93 3L \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: Difficult to assess JVP given habitus \nCARDIAC: PMI located in ___ intercostal space, midclavicular\nline. RRR, normal S1, S2. ___ systolic murmur loudest in aortic\nwindow,\nLUNGS: kyphosis. Resp were unlabored, no accessory muscle use. \nno\nwheezes or crackles\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: stasis dermatitis bilateral extremities \nPULSES: Distal pulses palpable and symmetric ', 'diagnoses': [{'icd_code': '42781', 'desc': 'Sinoatrial node dysfunction'}, {'icd_code': '28981', 'desc': 'Primary hypercoagulable state'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': '43320', 'desc': 'Occlusion and stenosis of vertebral artery without mention of cerebral infarction'}], 'summary': "Admission Labs\n\n___ 06:55AM BLOOD WBC-5.5 RBC-3.51* Hgb-9.2* Hct-30.5* \nMCV-87 MCH-26.2 MCHC-30.2* RDW-16.8* RDWSD-53.1* Plt ___\n___ 06:55AM BLOOD ___ PTT-26.5 ___\n___ 06:55AM BLOOD Plt ___\n___ 06:55AM BLOOD Glucose-94 UreaN-15 Creat-0.8 Na-144 \nK-4.1 Cl-95* HCO3-37* AnGap-12\n___ 06:55AM BLOOD Calcium-9.4 Phos-4.6* Mg-2.0\n___ 06:55AM BLOOD Digoxin-0.5*\n\nImaging\n\nCath ___\nCoronary Anatomy\nDominance: Right\n* Left Main Coronary Artery\nThe LMCA is normal.\n* Left Anterior Descending\nThe LAD is normal.\n* Circumflex\nThe Circumflex is normal.\n* Right Coronary Artery\nThe RCA is normal.\nIntra-procedural Complications: None\nImpressions:\nNormal coronary arteries.\nKnown severe aortic stenosis.\nRecommendations:\nFurther management as per primary cardiology team.\nOngoing evaluation for ___. \n\nDischarge Labs\n\n___ 06:25AM BLOOD WBC-4.4 RBC-3.42* Hgb-9.0* Hct-30.1* \nMCV-88 MCH-26.3 MCHC-29.9* RDW-16.6* RDWSD-53.1* Plt ___\n___ 06:25AM BLOOD Plt ___\n___ 06:25AM BLOOD Glucose-97 UreaN-16 Creat-0.8 Na-148* \nK-4.2 Cl-103 HCO3-37* AnGap-8*\n___ 06:25AM BLOOD Calcium-9.3 Phos-4.7* Mg-2.___ year old woman with severe AS,HFrEF pAF, hx of recent PE on \nEliquis, schizophrenia who presents as a direct admit for \npulmonary and AVR work-up given schizophrenia and concurrent \nsevere AS, COPD, and HFrEF. \n============\nAcute Issues\n============\n\n# COPD CLASS IV: FEV1 27% of predicted on PFTs on ___. On 3L \nhome O2. Per ___, changed inhaler to Advair along with \ntiotropium to add inhaled corticosteroid. ___ commented that \nshe was very high risk for open surgery, at higher than average \nrisk for pulmonary complications of ___ but that there was no \ndirect pulmonary contraindication for medically necessary \ncardiac procedure. They also noted that she is currently as \noptimized as possible pre-procedure. \n\n# dCHF \n# Severe AS: AVMax 4.2 m/s, peak and mean gradient of 69 and 49 \nmmHg, valve area 0.8. Aortic valve is likely the cause of \npatient's mild diastolic dysfunction. Remained euvolemic in \nhospital. Underwent LHC w/ no CAD noted. Started on metoprolol \ngiven diastolic dysfunction. Pt will require follow-up with Dr. \n___ team for ongoing w/u for ___. \n\n#pAF: Sinus rhythm on exam. Started on metop as above, continued \nhome digoxin (level 0.5 upon arrival). \n\n==============\nCHRONIC ISSUES\n==============\n# Schizophrenia: continude home Depakote, seroquel\n\n===============\nTransitional Issues\n===============\n1. Follow-up with Dr. ___ team for ___"}}
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{'final_diagnoses': ['Severe aortic stenosis', 'Chronic Obstructive Pulmonary Disease, class D', 'Diastolic heart failure', 'Atrial Fibrillation', 'Schizophrenia'], 'procedures': ['Cardiac catherization'], 'visit_summary': "============\nAcute Issues\n============\n\n# COPD CLASS IV: FEV1 27% of predicted on PFTs on ___. On 3L \nhome O2. Per ___, changed inhaler to Advair along with \ntiotropium to add inhaled corticosteroid. ___ commented that \nshe was very high risk for open surgery, at higher than average \nrisk for pulmonary complications of ___ but that there was no \ndirect pulmonary contraindication for medically necessary \ncardiac procedure. They also noted that she is currently as \noptimized as possible pre-procedure. \n\n# dCHF \n# Severe AS: AVMax 4.2 m/s, peak and mean gradient of 69 and 49 \nmmHg, valve area 0.8. Aortic valve is likely the cause of \npatient's mild diastolic dysfunction. Remained euvolemic in \nhospital. Underwent LHC w/ no CAD noted. Started on metoprolol \ngiven diastolic dysfunction. Pt will require follow-up with Dr. \n___ team for ongoing w/u for ___. \n\n#pAF: Sinus rhythm on exam. Started on metop as above, continued \nhome digoxin (level 0.5 upon arrival). \n\n==============\nCHRONIC ISSUES\n==============\n# Schizophrenia: continude home Depakote, seroquel\n\n===============\nTransitional Issues\n===============\n1. Follow-up with Dr. ___ team for ___", 'medications_prescribed': ['Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID \nRX *fluticasone-salmeterol [Advair Diskus] 500 mcg-50 mcg/dose 1 \nPUFF INH twice a day Disp #*1 Disk Refills:*1', 'Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet(s) by mouth once per day \nDisp #*30 Tablet Refills:*0', 'Apixaban 5 mg PO BID', 'Digoxin 0.125 mg PO EVERY OTHER DAY', 'Divalproex (EXTended Release) 500 mg PO QHS', 'Ferrous Sulfate 325 mg PO DAILY', 'Furosemide 40 mg PO DAILY', 'ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation \nQ6H:PRN', 'QUEtiapine Fumarate 400 mg PO QHS', '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': 43, 'gender': 'M', 'symptoms': 'Fall', 'medical_history': ['ALLERGIC RHINITIS', 'BILIARY SPHINCTEROTOMY', 'CHRONIC KIDNEY DISEASE', 'GASTROESOPHAGEAL REFLUX', 'HYPERCHOLESTEROLEMIA', 'HYPERTENSION', 'LEFT SCIATIC NEUROPATHY', 'OBSTRUCTIVE SLEEP APNEA', 'S/P CHOLECYSTECTOMY', 'S/P TONSILLECTOMY', 'GASTRIC BYPASS ___', 'DIABETES ___'], 'family_history': 'Mother DIABETES ___ \nFather DIABETES ___ \nSister DIABETES ___', 'present_illness': '___ with PMH HTN, CKD, HLD, GERD who presents after a fall 2 \ndays ago. She denies preceeding lightheadness, dizziness, CP, \nSOB but does not remember specific details surrounding event. \nDoes not believe that she tripped or slipped. She had URI last \nweek and still with cough productive of minimal brownish sputum. \nHad low grade fevers. last T 100.1 last night. Tmax 100.4 2 days \nago. She decided to come in today because she had right sided \npain in hip/ shoulder/ neck/ head after the fall.', 'medications': [{'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'BuPROPion (Sustained Release)', '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/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Oxcarbazepine', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Maalox/Diphenhydramine/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Flecainide Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '389', 'valuenum': 389.0, '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': '4.35', 'valuenum': 4.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '36.3', 'valuenum': 36.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': '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}], 'exams': 'ADMISSION EXAM\nVitals: T: 97.9 150/77 75 18 100% RA\nGeneral: Alert, oriented, no acute distress, obese female \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema. Pain on palpation of lateral right thigh. Minimal pain \nwith flexion of hip, but full strength intact. ___ ___ strength \nb/l, sensation intact to light touch in ___ b/l. ___ UE strength \nb/l. No point tenderness on shoulder, notes pain with active ROM \non flexion of shoulder radiating down upper arm with movement.\n\nDISCHARGE EXAM\nGeneral: Alert, oriented, no acute distress, obese female \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema. Pain on palpation of lateral right thigh. Minimal pain \nwith flexion of hip, but full strength intact. ___ ___ strength \nb/l, sensation intact to light touch in ___ b/l. ___ UE strength \nb/l. Full ROM at shoulder.', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V6284', 'desc': 'Suicidal ideation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "ADMISSION LABS\n\n___ 08:05AM WBC-5.4 RBC-4.69 HGB-14.0 HCT-43.2 MCV-92 \nMCH-29.8 MCHC-32.3 RDW-13.3\n___ 08:05AM URINE RBC-1 WBC-6* BACTERIA-FEW YEAST-NONE \nEPI-7 TRANS EPI-<1\n___ 08:05AM URINE BLOOD-TR NITRITE-NEG PROTEIN-100 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-5.5 LEUK-TR\n___ 08:05AM GLUCOSE-151* UREA N-21* CREAT-1.1 SODIUM-140 \nPOTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-26 ANION GAP-14\n___ 08:05AM cTropnT-<0.01\n___ 08:05AM CALCIUM-9.3 PHOSPHATE-3.5 MAGNESIUM-1.9\n\nDISCHARGE LABS\n___ 08:15AM BLOOD WBC-2.9* RBC-4.55 Hgb-13.5 Hct-42.4 \nMCV-93 MCH-29.7 MCHC-31.9 RDW-12.9 Plt ___\n___ 08:15AM BLOOD Glucose-112* UreaN-21* Creat-0.9 Na-141 \nK-4.1 Cl-107 HCO3-28 AnGap-10\n___ 08:15AM BLOOD Calcium-9.4 Phos-3.8 Mg-1.8\n\nMICROBIOLOGY:\n___ 1:02 am Influenza A/B by ___\n Source: Nasopharyngeal swab. \n\n **FINAL REPORT ___\n\n DIRECT INFLUENZA A ANTIGEN TEST (Final ___: \n Reported to and read back by ___ ___ ___ 12PM. \n POSITIVE FOR INFLUENZA A VIRAL ANTIGEN. \n\n DIRECT INFLUENZA B ANTIGEN TEST (Final ___: \n Negative for Influenza B. \n\nIMAGING\nCT HEAD ___\nIMPRESSION:\n \n1. No evidence of acute intracranial process.\n \n2. Opacified right mastoid air cells and partially opacified \nleft mastoid air cells, similar to ___. Mucosal thickening of \nthe paranasal sinuses, please correlate with symptoms. \n\nCXR ___:\nIMPRESSION: No acute cardiopulmonary process.\n\nPELVIS AND RIGHT HIP FILMS ___:\n\nFINDINGS: AP view of the pelvis. AP and frogleg views of the \nright hip. \nCorrelation is made to CT pelvis from ___. There \nis no acute\nfracture. Pubic symphysis and SI joints are grossly \nunremarkable. \nFemoroacetabular joint is anatomically aligned. Calcific \ndensity projecting\nover the pelvis on the right is compatible with calcified \nfibroid. Soft\ntissues are otherwise unremarkable.\n \nIMPRESSION: No fracture.\n___ with PMH HTN, CKD, HLD, GERD who presents after a fall 2 \ndays ago with right hip pain and URI symptoms, found to have \northostasis and influenza.\n\nACTIVE ISSUES\n\n# Fall/syncope: Differential included cardiac causes (eg MI, \narrythmia), neurologic eg. seizure, orthostasis, vaso-vagal, \nmechanical. Patient could not recall what happened well. EKG \nwas normal and troponin not elevated, no CP to suggest MI, and \nEKG without arrythmia. CT head negative. Orthostatics were \npositive for HR, given IVF with improvement by next morning. \nThought to be likely due to orthostasis in setting of decreased \nPO intake while ill with influenza.\n\n# Right hip/shoulder pain: This was mild in nature s/p fall and \nhip films were negative. She had full strength and ROM of both \njoints. Pain was managed with acetaminophen without difficulty. \n \n\n# URI: Flu positive. Patient was treated with oseltamivir x 5 \ndays.\n\nCHRONIC ISSUES\n \n# DM: Though patient denies having DM currently, she has \ndocumented notes pertaining to this recently in OMR; her most \nrecent A1c was 6.1% in ___ suggesting she has been able to \ncontrol this well. She is not on medication for DM at home. She \nrefused fingersticks and labs suggested she was well enough \ncontrolled that they were dc'd.\n\n# HTN: Lisinopril and metoprolol home doses continued.\n\n# HLD: Home statin continued.\n\nTRANSITIONAL ISSUES\n-Blood culture from ED pending at time of discharge"}}
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{'final_diagnoses': ['Syncope', 'Influenza'], 'procedures': ['None'], 'visit_summary': "___ with PMH HTN, CKD, HLD, GERD who presents after a fall 2 \ndays ago with right hip pain and URI symptoms, found to have \northostasis and influenza.\n\nACTIVE ISSUES\n\n# Fall/syncope: Differential included cardiac causes (eg MI, \narrythmia), neurologic eg. seizure, orthostasis, vaso-vagal, \nmechanical. Patient could not recall what happened well. EKG \nwas normal and troponin not elevated, no CP to suggest MI, and \nEKG without arrythmia. CT head negative. Orthostatics were \npositive for HR, given IVF with improvement by next morning. \nThought to be likely due to orthostasis in setting of decreased \nPO intake while ill with influenza.\n\n# Right hip/shoulder pain: This was mild in nature s/p fall and \nhip films were negative. She had full strength and ROM of both \njoints. Pain was managed with acetaminophen without difficulty. \n \n\n# URI: Flu positive. Patient was treated with oseltamivir x 5 \ndays.\n\nCHRONIC ISSUES\n \n# DM: Though patient denies having DM currently, she has \ndocumented notes pertaining to this recently in OMR; her most \nrecent A1c was 6.1% in ___ suggesting she has been able to \ncontrol this well. She is not on medication for DM at home. She \nrefused fingersticks and labs suggested she was well enough \ncontrolled that they were dc'd.\n\n# HTN: Lisinopril and metoprolol home doses continued.\n\n# HLD: Home statin continued.\n\nTRANSITIONAL ISSUES\n-Blood culture from ED pending at time of discharge", 'medications_prescribed': ['Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB or wheeze', 'gabapentin *NF* 250 mg/5 mL Oral TID \nTake 20 ml three times daily', 'Lisinopril 5 mg PO DAILY', 'Metoprolol Tartrate 50 mg PO BID', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Ranitidine (Liquid) 150 mg PO BID', 'Simvastatin 40 mg PO DAILY', 'TraMADOL (Ultram) 50 mg PO TID:PRN pain', 'Oseltamivir 75 mg PO Q12H \nRX *oseltamivir [Tamiflu] 75 mg 1 capsule(s) by mouth twice a \nday Disp #*9 Capsule Refills:*0', 'calcium carb-mag oxide-vit D3 *NF* 500-40-250 mg-mg-unit \nOral BID \nDose uncertain', 'Loratadine *NF* 10 mg Oral DAILY', 'potassium citrate-citric acid *NF* 1100-334 mg/5 mL ORAL BID \n\nTake 10 ml twice 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': '___ y/o F DM1, ESRD on dialysis p/w nausea, hyponatremia. In \nmiddle of dialysis pt suddenly experienced nausea, vomiting w/ \nbile, diaphresis. Ongoing nausea, so got fluid back at dialysis. \nNo chest pain, shortness of breath, fever, chills, sore throat, \nsinus congestions, dysuria.', 'medical_history': ['- Type 1 diabetes mellitus complicated by neuropathy, \nretinopathy, and nephropathy', '- End stage renal disease on dialysis, goes ___', '- s/p LUE AV fistula ___ which failed to mature, thrombosed and \n \nfailed thrombectomy. Now has R IJ permacath, h/o inxn in past \ncatheter ___', '- Hypertension', '- Hyperlipidemia', '- Anemia of chronic disease', '- Right Charcot Foot', '- s/p Left Toe Amputation', '- Hypothyroidism'], 'family_history': 'mom- DM, CAD, stroke, dad - CAD, MGM -HF', 'present_illness': 'In ED, Temp 97.1 HR 66 BP 183/64 RR 16 Pox 100% RA. Troponin at \nbaseline 0.3, EKG unchanged from prior. On exam no focal \nfindings. ___ noted to be hyponatremic which per renal is \ndue to diasylate bath. Admitted for ___ and observation. \nCurrent vitals 173/65 HR 68 O2 sat 97% RA on transfer.', 'medications': [{'medication': 'Clopidogrel', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.47', 'valuenum': 1.47, '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': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '82.0', 'valuenum': 82.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '258', 'valuenum': 258.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.46', 'valuenum': 0.46, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.11', 'valuenum': 9.11, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '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': '69', 'valuenum': 69.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '___', 'valuenum': 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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-61', 'valuenum': -61.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, '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': '43.7', 'valuenum': 43.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.6, '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': 114.0, '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': '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': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'Ratio', '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': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 82.0, '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': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '9', 'valuenum': 9.0, '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': '191', 'valuenum': 191.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, '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': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '33.3', 'valuenum': 33.3, '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': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.73', 'valuenum': 3.73, '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': '42.2', 'valuenum': 42.2, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2', 'valuenum': 2.0, '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': '2.6', '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '238', 'valuenum': 238.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/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': '2', 'valuenum': 2.0, '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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TR*.'}, {'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': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.009', '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': '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': '156', 'valuenum': 156.0, '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': 'DONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '23', 'valuenum': 23.0, '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '40.9', 'valuenum': 40.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.26', 'valuenum': 4.26, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '44.4', 'valuenum': 44.4, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, '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': '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM\nVitals T 99.1, BP 142/74, HR 69, RR 16, O2 sat 99% RA \nGnl: NAD, Alert and oriented x 3 \nHEENT: PERRLA, Anicteric, MMM, no JVD \nCV: RRR, Normal S1 + S2, ___ SEM, rubs or gallops \nUE: left arm with graft + thrill \nResp: Clear to auscultation bilaterally, No wheezes or crackles \n\nAbd: Soft, Nontender, NABS, No hepatosplenomegaly \nExtremities: No cyanosis, clubbing or edema \nskin/nails: No rashes/no jaundice/no splinters \nNeuro: AAOx3. Cn II-XII intact. ___ strength throughout. No \nsensory deficits to light touch appreciated. \nRectal: not done\n\nDISCHARGE EXAM: unchanged from prior', 'diagnoses': [{'icd_code': 'I639', 'desc': 'Cerebral infarction, unspecified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'R4701', 'desc': 'Aphasia'}, {'icd_code': 'R200', 'desc': 'Anesthesia of skin'}, {'icd_code': 'R29701', 'desc': 'NIHSS score 1'}, {'icd_code': 'I6523', 'desc': 'Occlusion and stenosis of bilateral carotid arteries'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I672', 'desc': 'Cerebral atherosclerosis'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'E7800', 'desc': 'Pure hypercholesterolemia, unspecified'}], 'summary': '___ 01:10PM BLOOD WBC-8.4 RBC-4.73 Hgb-13.2 Hct-44.4 MCV-94 \nMCH-27.9 MCHC-29.8* RDW-16.5* Plt ___\n___ 01:10PM BLOOD Glucose-217* UreaN-20 Creat-4.2* Na-129* \nK-4.5 Cl-93* HCO3-25 AnGap-16\n___ 05:25AM BLOOD Glucose-180* UreaN-38* Creat-5.9*# \nNa-132* K-4.5 Cl-95* HCO3-24 AnGap-18\n___ 07:01PM BLOOD ALT-17 AST-68* AlkPhos-72 TotBili-0.3\n___ 01:10PM BLOOD Calcium-9.9 Phos-3.7 Mg-1.9\n___ 05:25AM BLOOD Osmolal-298\n___ 12:30PM BLOOD Ethanol-NEG\n\n___\n___ 01:10PM BLOOD CK(CPK)-30\n___ 07:01PM BLOOD CK(CPK)-62\n___ 05:25AM BLOOD CK(CPK)-16*\n___ 07:01PM BLOOD CK-MB-NotDone cTropnT-0.02*\n___ 05:25AM BLOOD CK-MB-NotDone cTropnT-0.02*\n\n___ CXR: FINDINGS: As compared to the previous examination, \nthere is no relevant change. Normal size of the cardiac \nsilhouette, mild left basal atelectasis. Minimal generalized \ninterstitial markings, suggestive of subtle chronic fluid \noverload. No evidence of frank pulmonary edema. No pneumothorax, \nno newly appeared focal parenchymal opacities suggesting \npneumonia. \n\n___ EKG: sinus at 67, nl intervals, nl axis, no acute ST/T \nchanges, TWI aVL, aVR, V1, delayed r wave progression compared \nwith ___ similar. \n\n___ Blood Cultures pending\n___ year old type 1 DM, HTN, ESRD on dialysis with onset \nnausea/vomiting at HD that resolved within 6 hours. Nausea: \nunclear precipitant. ___ does have prior history of \ngastroporesis and ate a large lunch just prior to dialysis. \n___ unable to provide urine sample given makes little, but \nno urinary symptoms. No other focal signs of infection.\n-- Blood cultures to be followed up by primary care physician\n\n___ noted to have mild hyponatremia which improved over \nnight and is likely related to her diasylate bath. ___ with \npoorly controlled type 1 diabetes mellitus without evidence of \ninfection. ___ was instructed to increased her lantus to 17 \nunits qhs, given prior efforts to have her take AM and ___ lantus \nhave failed. ___ was instructed to call and schedule an \nappointment with her ___ provider who she had not seen in ___ \nyears.\n\n___ was maintained on her home medications for her \nhypertension, hyperlipidemia, hypothyroidism, and neuropathic \npain.\n-- ___ was noted to have mildly elevated AST at 68 that \nshould be repeated when she sees her PCP.\n\nFor prophylaxis ___ was maintained on her home PPI, \ndocusate. ___ was on heparin sc for DVT prophylaxis. ___ \nwas full code during this admission.'}}
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{'final_diagnoses': ['Diagnosis: Nausea'], 'procedures': ['None'], 'visit_summary': '___ year old type 1 DM, HTN, ESRD on dialysis with onset \nnausea/vomiting at HD that resolved within 6 hours. Nausea: \nunclear precipitant. ___ does have prior history of \ngastroporesis and ate a large lunch just prior to dialysis. \n___ unable to provide urine sample given makes little, but \nno urinary symptoms. No other focal signs of infection.\n-- Blood cultures to be followed up by primary care physician\n\n___ noted to have mild hyponatremia which improved over \nnight and is likely related to her diasylate bath. ___ with \npoorly controlled type 1 diabetes mellitus without evidence of \ninfection. ___ was instructed to increased her lantus to 17 \nunits qhs, given prior efforts to have her take AM and ___ lantus \nhave failed. ___ was instructed to call and schedule an \nappointment with her ___ provider who she had not seen in ___ \nyears.\n\n___ was maintained on her home medications for her \nhypertension, hyperlipidemia, hypothyroidism, and neuropathic \npain.\n-- ___ was noted to have mildly elevated AST at 68 that \nshould be repeated when she sees her PCP.\n\nFor prophylaxis ___ was maintained on her home PPI, \ndocusate. ___ was on heparin sc for DVT prophylaxis. ___ \nwas full code during this admission.', 'medications_prescribed': ['1. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).', '3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. Epoetin Alfa 10,000 unit/mL Solution Sig: 10,000 units \nInjection ASDIR (AS DIRECTED): at dialysis.', '7. Sevelamer HCl 400 mg Tablet Sig: Two (2) Tablet PO TID \nW/MEALS (3 TIMES A DAY WITH MEALS).', '8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', '9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', '10. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap \nPO DAILY (Daily).', '11. Levothyroxine 125 mcg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '12. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).', '13. Oxycodone-Acetaminophen ___ mg Tablet Sig: One (1) Tablet \nPO Q6H (every 6 hours) as needed for pain.', '14. Lantus 100 unit/mL Solution Sig: Seventeen (17) units \nSubcutaneous at bedtime.', '15. Humalog 100 unit/mL Solution Sig: per sliding scale \nSubcutaneous QIDAC.', '16. Doxazosin 2 mg Tablet Sig: One (1) Tablet PO QAM.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'M', 'symptoms': 'admit for hyponatremia, fatigue', 'medical_history': ['HCC - as above', 'Hepatitis C - s/p antiviral therapy', 'type II insulin dependent diabetes mellitus', 's/p arthroscopic knee surgery'], 'family_history': 'Mother had breast cancer at ___; died at ___\nFather had chronic leukemia', 'present_illness': '___ is a ___ man with hepatocellular cancer, diagnosed \nin ___, admitted today with hyponatremia and fatigue.\n\nMr. ___ initially presented in ___ with RUQ pain and was \nfound to have a 15cm lesion involving the right liver, 2.7cm \nmass in the left liver, and 1.5cm lesion adjacent to the \ngallbladder fossa. He underwent right portal vein embolization. \n Although taken to the operating room in ___, he was found to \nhave unresectable bilateral disease. He then underwent \nchemoembolization in ___ and ___. He began treatment with \nRAD001 on trial in ___. Subsequent imaging in ___ showed \ndisease progression, and was then started on sorafenib three \nweeks ago.\n\nMr. ___ was seen today in clinic where he reported larygitis \nfor three days, progressive fatigue, and one week of \nnonproductive cough, and was found to have sodium of 121mEq. He \nwas admitted for futher work-up. He denies having had fever, \nheadache, chest pain, shortness of breath, abdominal pain, \nnausea, vomiting, diarrhea. He reports having adequate po \nintake including two Boost per day, fruit, one glass of water, \nwhich he reports is consistent with previous intake. He also \nnoted sore throat and "white tongue," both of which improved \nsomewhat today. He denies having had sick contacts.', 'medications': [{'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAYS', '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': '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': 'DAYS', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.016', 'valuenum': 1.016, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'POS', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': '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': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 123.0, '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': 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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '26.3', 'valuenum': 26.3, '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': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '267', 'valuenum': 267.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'T 97.8 HR 85 BP 146/86 RR 16 98%RA\nGEN: alert and oriented x3, comfortable, no acute distress\nHEENT: PERRL, anicteric, conjunctiva pink, dry oropharynx, no \nthrush or ulcers\nLYMPH: no anterior/posterior cervical, occipital, \nsupraclavicular, or axillary adenopathy\nCARDIOVASCULAR: PMI nondisplaced, regular rate and rhythm \nwithout murmurs, rubs, or gallops\nLUNGS: clear to auscultation bilaterally without rhonchi, \nwheezes, or crackles\nABDOMEN: soft, modestly tender to palpation right upper \nquadrant; no rebounding or guarding, nondistended with normal \nactive bowel sounds. no masses. no hepatosplenomegaly by \npercussion or palpation\nEXTREMITIES: no clubbing, cyanosis, or edema\nSKIN: no rashes, petechia, lesions, or echymoses\nNEURO: A&Ox3, cranial nerves II-XII intact, strength ___ \nthroughout', 'diagnoses': [{'icd_code': '71691', 'desc': 'Arthropathy, unspecified, shoulder region'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '7140', 'desc': 'Rheumatoid arthritis'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}], 'summary': 'ADMIT: \nGlucose-177* UreaN-20 Creat-0.7 Na-121* K-5.1 Cl-88* HCO3-22 \nAnGap-16\n\nWBC-13.7* HCT-36.0* MCV-85\n\n ALT-258* AST-87* LD(LDH)-237 AlkPhos-180* TotBili-2.4*\n\nDISCHARGE: \nGlucose-145* UreaN-23* Creat-0.5 Na-132* K-4.6 Cl-102 HCO3-24 \nAnGap-11\n\nWBC-9.2 Hct-31.2* MCV-89 Plt ___\n\nALT-146* AST-59* AlkPhos-178* TotBili-1.6*\n\nOsmolal-258*\n\nBlood Cx, Urine Cx, Legionella Ag all negative\n___ with advanced HCC on sorafenib, admitted with \nhyponatremia, fatigue, and laryngitis\n\n# Hyponatremia: Pt was hypovolemic on admission based on exam \nand history. He was given several liters of IVF for volume \nrepletions but sodium continued to trend down. When sodium was \nbelow 120 he was transfered to the FICU for volume repletion \nwith hypertonic saline. His urine osms were greater than 350, \nurine sodium was 13. It was believed that the low urine sodium \nwas dependent on the sodium intake, and urine osms supported \nSIADH. Renal was following and believed hyponatremia to be \nsecondary to his tumor. He was fluid restricted and started on \nhypertonic saline at a rate of 25cc/hr. Serum sodium levels \nimproved from initial 118 to 129 at which hypertonic saline was \nstopped and pt was started on 1L fluid restriction per renal \nrecs. He was also started on a high salt, high protein diet. \nSodium increased back to 131 and he was transferred back to OMED \nfor further treatment. Review of the most recent CT abdomen by \nradiology showed no new foci of necrosis that may have \nprecipitated this repeat hyponatremia. On the day of discharge \nhis sodium normalized and he felt well. He was to f/u with his \noncologist 1 week after discharge with fluid restriction of \n1L/day and salt tablets. \n\n# Fatigue: Pt has chronic fatigue, which did not improve \nduring his stay. he maitained activity and appetite. \n\n# Laryngitis: ddx includes viral URI vs thrush, although \noropharynx appearance was not consistent with thrush, and by \ndischarge patient had improvement in both laryngitis and white \ntongue plaque.\n\n# Type II insulin dependent diabetes: Was well-controlled \nthroughout the admission on NPH ___ QAM per home regimen; \nHumalog sliding scale with meals per home regimen. \n\n# Hyperbilirubinemia: Bilirubin had been elevated for \napproximately one week. Ct demonstrated no obstructive porcess. \nBilirubin was normalizing throughout the admission.'}}
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{'final_diagnoses': ['primary: hyponatremia, SIADH', 'secondary: hepatocellular carcinoma'], 'procedures': ['None'], 'visit_summary': '___ with advanced HCC on sorafenib, admitted with \nhyponatremia, fatigue, and laryngitis\n\n# Hyponatremia: Pt was hypovolemic on admission based on exam \nand history. He was given several liters of IVF for volume \nrepletions but sodium continued to trend down. When sodium was \nbelow 120 he was transfered to the FICU for volume repletion \nwith hypertonic saline. His urine osms were greater than 350, \nurine sodium was 13. It was believed that the low urine sodium \nwas dependent on the sodium intake, and urine osms supported \nSIADH. Renal was following and believed hyponatremia to be \nsecondary to his tumor. He was fluid restricted and started on \nhypertonic saline at a rate of 25cc/hr. Serum sodium levels \nimproved from initial 118 to 129 at which hypertonic saline was \nstopped and pt was started on 1L fluid restriction per renal \nrecs. He was also started on a high salt, high protein diet. \nSodium increased back to 131 and he was transferred back to OMED \nfor further treatment. Review of the most recent CT abdomen by \nradiology showed no new foci of necrosis that may have \nprecipitated this repeat hyponatremia. On the day of discharge \nhis sodium normalized and he felt well. He was to f/u with his \noncologist 1 week after discharge with fluid restriction of \n1L/day and salt tablets. \n\n# Fatigue: Pt has chronic fatigue, which did not improve \nduring his stay. he maitained activity and appetite. \n\n# Laryngitis: ddx includes viral URI vs thrush, although \noropharynx appearance was not consistent with thrush, and by \ndischarge patient had improvement in both laryngitis and white \ntongue plaque.\n\n# Type II insulin dependent diabetes: Was well-controlled \nthroughout the admission on NPH ___ QAM per home regimen; \nHumalog sliding scale with meals per home regimen. \n\n# Hyperbilirubinemia: Bilirubin had been elevated for \napproximately one week. Ct demonstrated no obstructive porcess. \nBilirubin was normalizing throughout the admission.', 'medications_prescribed': ['1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours): Please take last dose on ___.Disp:*2 Tablet(s)* Refills:*0*', '2. Sodium Chloride 1 gram Tablet Sig: Two (2) Tablet PO TID (3 \ntimes a day).Disp:*180 Tablet(s)* Refills:*2*', '3. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: 25 Units \n Subcutaneous QAM. ', '4. Insulin Lispro 100 unit/mL Cartridge Sig: 10 Units \nSubcutaneous QAM: 10 units before meals SQ three times a day \nsliding scale. ', '5. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO \nevery eight (8) hours. ']}
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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': 'Hyperglycemia after starting dexamethasone', 'medical_history': ['1. Meningioma', '2. CAD s/p MI in ___. Repeat cath here in ___ revealed patent \ncoronaries', '3. sCHF (no echo in our system but ___ admission at OSH for \nCHF)', '4. Diabetes', '5. Hypertension', '6. Dyslipidemia', '7. Left ear infection, hearing loss, had surgery', '8. Colon polyps removed', '9. Bilateral ___ blood clots', '10. Sleep apnea, does not tolerate CPAP', '11. Prostatism', '12. Cognitive decline'], 'family_history': 'No family history of brain cancer, otherwise non-contributory', 'present_illness': "Mr. ___ is a ___ year old man with a history of CAD s/p MI in \n___ (subsequent normal cath in ___, CVA w/o residual \ndefecits, sCHF, DMII, OSA (nonadherant with bipap), who is \nadmitted for preoperative hyperglycemia management prior to \nmeningioma removal scheduled for ___. Per the patient and \npatient's family, he was in his usual state of health until this \n___ when he and his family noticed headaches and generalized \ncognitive decline. He began forgetting dates and mixing up his \nmedications. He then went to ___ on ___ where an \nMRI revealed a large frontal meningioma. He was then seen by \nneurosurgery there who recommended surgery, however, he decided \nto come to ___ for a second opinion. He then established care \nhere with neurooncology who noted RLE edema and obtained an U/S \nwhich revealed a DVT. He was started on lovenox. It is unclear \nif this is provoked or not. He was started on dexamethasone and \nKeppra for his meningioma but he has developed hyperglycemia as \na result. His neurosurgeons therefore decided the patient should \nbe admitted to medicine for hyperglycemia management prior to \nthe operation. Of note, his aspirin and plavix were discontinued \non ___ in preparation of surgery.", 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': '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': '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': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.8, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '155', 'valuenum': 155.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, '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': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', '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': '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}, {'value': '27.9', 'valuenum': 27.9, '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': '22.9', 'valuenum': 22.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '377', 'valuenum': 377.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '26.1', 'valuenum': 26.1, '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': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, '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': '195', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, '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': '3.6', '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': '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': 4.0, 'valueuom': 'units', 'ref_range_lower': 0.0, 'ref_range_upper': 19.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE <20, BORDERLINE 20-30, POSITIVE >30. METHOD IS ___ (IGA ANTI-HUMAN TTG). IN IGA DEFICIENCY, MAY BE FALSELY NEGATIVE.'}, {'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': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', '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': '371', 'valuenum': 371.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission exam:\nVS: 97.8 124/74 88 18 95%RA ___ 240\nGENERAL: Well-appearing man in NAD, comfortable, appropriate.\nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.\nNECK: Supple, no thyromegaly, no JVD, no carotid bruits.\nHEART: RRR, no MRG, nl S1-S2.\nLUNGS: CTA bilat, no rh/wh, good air movement, resp unlabored. \nBibasilar crackles.\nABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding. Scar \nfrom colectomy for polyps (precancerous).\nEXTREMITIES: WWP, no c/c, 2+ peripheral pulses. 1+ edema on RLE.\n \nSKIN: No rashes or lesions.\nLYMPH: No cervical LAD.\nNEURO: Awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout ___ flexion/extension with subtle RLE weakness \non knee flexion and extension, sensation grossly intact \nthroughout, DTRs 2+ and symmetric, cerebellar exam intact, \nsteady gait but with limp favoring right and + rhomberg sign. \nStates days of week backward correctly without delay and states \nhe is in hospital for meningioma to be removed.\n\nDischarge exam: Unchanged', 'diagnoses': [{'icd_code': '5789', 'desc': 'Hemorrhage of gastrointestinal tract, unspecified'}, {'icd_code': '53085', 'desc': "Barrett's esophagus"}, {'icd_code': '4550', 'desc': 'Internal hemorrhoids without mention of complication'}, {'icd_code': '4553', 'desc': 'External hemorrhoids without mention of complication'}, {'icd_code': '7019', 'desc': 'Unspecified hypertrophic and atrophic conditions of skin'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': '___:45AM BLOOD WBC-9.7 RBC-4.59* Hgb-14.8 Hct-43.4 \nMCV-95 MCH-32.4* MCHC-34.2 RDW-12.7 Plt ___\n___ 09:45AM BLOOD Neuts-78.8* Lymphs-14.6* Monos-4.8 \nEos-1.2 Baso-0.6\n___ 09:45AM BLOOD Plt ___\n___ 09:45AM BLOOD ___ PTT-26.3 ___\n___ 09:45AM BLOOD UreaN-14 Creat-0.6 Na-143 K-4.3 Cl-103 \nHCO3-29 AnGap-15\n___ 09:45AM BLOOD Calcium-10.0\n___ 09:45AM BLOOD %HbA1c-8.2* eAG-189*\n___ 09:45AM BLOOD CRP-14.1*\n\n___ ct brain\nFINDINGS: The patient is status post post-left frontal \ncraniotomy, with \nchanges related to excision of the previously described left \nfrontal mass. A moderate amount of pneumocephalus is noted in \nthe left frontal region. Trace amount of dense material is seen \nlayering in the resection cavity, compatible with subarachnoid \nblood. The sulci of the left frontal lobe are mildly effaced as \nis the frontal horn of the left lateral ventricle. Subtle \nleft-to-right shift of midline structures is seen, with the \nmaximum \ndisplacement measuring 3 mm in the transverse plane (2; 15). \nOtherwise, there is no large subdural collection, hydrocephalus, \nor intraventricular \nhemorrhage. Small amount of subcutaneous gas is seen along the \nleft aspect of the scalp in the region of the surgical \nintervention. The visualized \nparanasal sinuses and mastoid air cells are clear. Incidental \nnote is made of a hearing aid on the left ear. \n \nIMPRESSION: Immediately status post resection of left \nfrontovertex \nextra-axial mass, with moderate post-procedural pneumocephalus \nand trace \nsubarachnoid blood at the operative bed; mild effacement of \nsulci and the left frontal horn, with 3 mm rightward shift of \nmidline structures, is unchanged from the pre-operative studies. \n\n \n___ MRI\n\nFINDINGS: \n \nThe patient is status post left frontal craniotomy, with \npost-surgical changes in the left frontal region as well as the \nadjacent parenchyma of the left frontal lobe. \nPneumocephalus and blood products and fluid are noted. There is \nmoderate \nsurrounding FLAIR hyperintense signal that is not significantly \nchanged from the preop study. Areas of increased signal \nintensity are noted on the DWI sequence in the periphery of the \nresection cavity with decreased signal on the ADC sequence, \nwhich may relate to blood products/areas of ischemia or \ninfarction in the adjacent tissue. Attention on followup can be \nconsidered (series 502, image 20). \n \n \nEvaluation for enhancing areas is limited, given the \npre-contrast T1 \nhyperintense areas. However, there is slightly vague enhancement \nsurrounding the surgical resection cavity. No areas of abnormal \nenhancement are noted elsewhere in the brain. Small fluid \ncollection is noted in the left subdural space, in the frontal \nregion. There is also soft tissue swelling with fluid collection \nin the soft tissues overlying the left frontal and the parietal \nbones (series 6, image 21) along \nwith blood products. Mild enhancement of the overlying dura in \nthe left side. Multiple FLAIR hyperintense foci are also noted \nin the cerebral white matter, likely related to small vessel \nischemic changes. There is mass effect on the frontal horn of \nthe left lateral ventricle, with mild rightward shift of the \nmidline structures and subfalcine herniation measuring \napproximately 5 mm. The major intracranial arterial flow voids \nare noted, with a diminutive distal vertebral and Basilar artery \nwith a fetal PCA pattern. There is increased signal intensity in \nthe mastoid air cells on both sides and in the petrous apices \nfrom fluid/mucosal thickening. \n \nIMPRESSION: \n1. Surgical changes in the left frontal region and in the left \nfrontal lobe parenchyma with presence of blood products as \ndescribed above. Unchanged appearance of the surrounding FLAIR \nhyperintense signal in the left frontal lobe. Interval \ndevelopment of an area of decreased diffusion surrounding the \nblood products, which may relate to infarction/ischemic changes \nin the parenchyma. Assessment for infarction is limited given \nthe presence of blood products adjacent. Consider followup as \nclinically indicated for better assessment. \n \n2. While there is no significant abnormal enhancement to suggest \nan obvious residual tumor, followup evaluation can be considered \nto assess residual tumor, after resolution of the post-surgical \nchanges. \n \n3. Mucosal thickening/fluid, in the mastoid air cells on both \nsides and in \nthe petrous apices. Persistent mass effect on the left frontal \nhorn and mild rightward shift of midline structures not \nsignificantly changed.\n___ with CAD s/p MI, chronic diastolic CHF (EF 50%), T2DM, h/o \nCVA and recently diagnosed DVT who was admitted for \npre-operative glycemic control in the setting of dexamethasone.\n\n#Meningioma - Patient noted having gait instability and \ndifficulty with his memory, was diagnosed with a left frontal \nmeningioma by MRI at an OSH. Was started on dexamethasone and \nKeppra for seizure prophylaxis. He had resection of the \nmeningioma on ___ by neurosurgery. This was done without \ncomplication. Post op head CT was without hematoma. Post op MRI \nrevealed good resection. \n\n#T2DM - Patient reports that his diabetes had not been well \ncontrolled prior to starting dexamethasone, was reporting sugars \nin the 200s previously. Since starting dex, his glycemic \ncontrol even worsened and was reporting glucose in the 400s. He \nwas admitted for pre-operative glycemic control. We held his \nhome glipizide and started him on insulin. By the day of \nsurgery, his sugars remained elevated but were improved from \nprior to admission. His insulin regimen was Lantus 15 units and \nsliding scale Humalog. During his post-operative course he was \non dexamethazone and his sugars were difficult to control. He \nwas placed on an insulin drip for > 24 hours. A ___ Diabetes \nconsult was obtained. He was transferred to a sliding scale and \nPO meds were discontinued. His sliding scale insulin and \nMorning Lantus doses were adjusted and weaned per ___ consult \nin the setting of steroid taper.\n\n#DVT - He reports having a history of at least 2 prior DVTs. \nWas diagnosed with DVT prior to admission, had been on Lovenox. \nWas placed on a heparin gtt during this admission given his \npending surgery. Heparin was turned off approximately 6 hours \nprior to his surgery. Post operative day #1 he was asa was \nrestarted and on post-operative day #2 his plavix was restarted. \nOn ___ he was started on Coumadin.\n\n#CAD s/p MI - Had cardiac cath in ___ which did not show any \nsignificant lesions. He was continued on his home metoprolol, \nvalsartan and amlodipine. He was continued on his cardiac meds \non the day of the operation.\n\n#Diastolic CHF - TTE from OSH showed an EF of 50%. There were \nno clinical signs of volume overload, was given gentle fluids on \nthe day of surgery while he was NPO.\n\n#OSA - Was continued on CPAP while he was an inpatient.\n\nOn ___ he was cleared for discharge home after being seen by \n___. Pain was well controlled, tolerating a PO diet, voiding \nwithout difficulty and ambulating independently. He received \nInsulin training prior to discharge and will have ___ at home \nfor furhter training. Family was in agreement with this plan.'}}
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{'final_diagnoses': ['Meningioma s/p resection', 'Hyperglycemia', 'CAD', 'Diastolic CHF', 'OSA'], 'procedures': ['___: LEFT FRONTAL CRANIOTOMY FOR MENIGIOMA RESECTION'], 'visit_summary': '___ with CAD s/p MI, chronic diastolic CHF (EF 50%), T2DM, h/o \nCVA and recently diagnosed DVT who was admitted for \npre-operative glycemic control in the setting of dexamethasone.\n\n#Meningioma - Patient noted having gait instability and \ndifficulty with his memory, was diagnosed with a left frontal \nmeningioma by MRI at an OSH. Was started on dexamethasone and \nKeppra for seizure prophylaxis. He had resection of the \nmeningioma on ___ by neurosurgery. This was done without \ncomplication. Post op head CT was without hematoma. Post op MRI \nrevealed good resection. \n\n#T2DM - Patient reports that his diabetes had not been well \ncontrolled prior to starting dexamethasone, was reporting sugars \nin the 200s previously. Since starting dex, his glycemic \ncontrol even worsened and was reporting glucose in the 400s. He \nwas admitted for pre-operative glycemic control. We held his \nhome glipizide and started him on insulin. By the day of \nsurgery, his sugars remained elevated but were improved from \nprior to admission. His insulin regimen was Lantus 15 units and \nsliding scale Humalog. During his post-operative course he was \non dexamethazone and his sugars were difficult to control. He \nwas placed on an insulin drip for > 24 hours. A ___ Diabetes \nconsult was obtained. He was transferred to a sliding scale and \nPO meds were discontinued. His sliding scale insulin and \nMorning Lantus doses were adjusted and weaned per ___ consult \nin the setting of steroid taper.\n\n#DVT - He reports having a history of at least 2 prior DVTs. \nWas diagnosed with DVT prior to admission, had been on Lovenox. \nWas placed on a heparin gtt during this admission given his \npending surgery. Heparin was turned off approximately 6 hours \nprior to his surgery. Post operative day #1 he was asa was \nrestarted and on post-operative day #2 his plavix was restarted. \nOn ___ he was started on Coumadin.\n\n#CAD s/p MI - Had cardiac cath in ___ which did not show any \nsignificant lesions. He was continued on his home metoprolol, \nvalsartan and amlodipine. He was continued on his cardiac meds \non the day of the operation.\n\n#Diastolic CHF - TTE from OSH showed an EF of 50%. There were \nno clinical signs of volume overload, was given gentle fluids on \nthe day of surgery while he was NPO.\n\n#OSA - Was continued on CPAP while he was an inpatient.\n\nOn ___ he was cleared for discharge home after being seen by \n___. Pain was well controlled, tolerating a PO diet, voiding \nwithout difficulty and ambulating independently. He received \nInsulin training prior to discharge and will have ___ at home \nfor furhter training. Family was in agreement with this plan.', 'medications_prescribed': ['1. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*', '4. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day).\nDisp:*120 Tablet(s)* Refills:*2*', '5. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. valsartan 80 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '7. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '8. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '9. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '10. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: \nCheck INR on ___ or ___. Further dosing by PCP.\nDisp:*30 Tablet(s)* Refills:*2*', '11. dexamethasone 1 mg Tablet Sig: taper Tablet PO taper for 4 \ndays: 1mg PO Qday on ___ & ___. 0.5mg PO Qday on ___ then \nd/c.\nDisp:*qs Tablet(s)* Refills:*0*', '12. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain.', '13. insulin glargine 100 unit/mL Solution Sig: ___ (55) \nunits Subcutaneous once a day: Decrease to 35 units daily when \ntaking 1mg Dexamethasone daily and decrease to 25 units daily \nwhen taking 0.5mg Dexamethasone daily.\nDisp:*1 vial* Refills:*3*', '14. Humalog 100 unit/mL Solution Sig: per sliding scale units \nSubcutaneous before meals.\nDisp:*1 vial* Refills:*2*', '15. diabetic supplies, miscellan. Kit Sig: One (1) kit \nMiscellaneous as directed.\nDisp:*1 kit* Refills:*2*', '16. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily).\nDisp:*30 Patch 24 hr(s)* Refills:*2*', '17. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID \n(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': 68, 'gender': 'F', 'symptoms': 'chest pain', 'medical_history': ['s/p adenoidectomy'], 'family_history': 'There is no family history of premature coronary artery disease \nor sudden death. Sister has supraventricular tachycardia. Mother \nwith hyperthyroidism. Father is healthy.', 'present_illness': 'PCP: ___ ___\n\n___ m with no significant PMH p/w dull occasional chest pain with \nradiation to jaw for past 2 days mostly at night. Last week he \nhad a "bad flu" with subjective fevers, chills, mild body aches, \nmild cough, and sore throat. The "flu" symptoms resolved \ncompletely on 2 days prior to presentation. On the night 2 days \nprior to admission he developed sudden onset of dull achy pain \nin the middle of his chest while he was lying in bed. He stated \nthat pain made his jaw hurt and throb. This was associated with \ntingling of both arms. The symptoms resolved spontaneously. The \nsymptoms recurred and were more severe prompting his \npresentation to the ED. The episodes lasted from 30 mins to 1.5 \nhours. He denies shortness of breath, DOE, \nnausea/vomiting/diaphoresis. The pain had no relation to \nactivity nor body position. He tried ibuprofen for pain relief, \nbut did not find it helped his symptoms. He denies abdominal \npain, diarrhea, or hematuria.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'GlyBURIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Fish Oil (Omega 3)', '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': 'Magnesium Oxide', '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', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Paroxetine', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 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 = 61 if non African-American (mL/min/1.73 m2). Estimated GFR = 74 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.04, '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': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, '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': '33.2', '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': '149', 'valuenum': 149.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.49', 'valuenum': 4.49, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.8', 'valuenum': 41.8, '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': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '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': '4.4', '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': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.05, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}], 'exams': 'VS - 98.7 129/61 73 18 99% RA pain ___ wt 140 ht 70inch \npulsus 5mmHg \nGen: WDWN thin young male in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. PERRLA, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNeck: Supple with flat JVP. \nCV: PMI located in ___ intercostal space, midclavicular line. \nRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nAbd: Soft, flat, NT No HSM or tenderness. Abd aorta not enlarged \nby palpation. No abdominal bruits. \nExt: No c/c/e. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. no rash \nover face/trunk/arms/legs \n \nPulses: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': 'I25118', 'desc': 'Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris'}, {'icd_code': 'I25708', 'desc': 'Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E780', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}], 'summary': "___ 12:20PM BLOOD WBC-10.0 RBC-4.47* Hgb-14.2 Hct-39.9* \nMCV-89 MCH-31.7 MCHC-35.5* RDW-12.0 Plt ___\n___ 02:15AM BLOOD Neuts-81.5* Lymphs-12.7* Monos-3.9 \nEos-1.5 Baso-0.4\n___ 12:20PM BLOOD Glucose-115* UreaN-10 Creat-0.9 Na-139 \nK-5.1 Cl-100 HCO3-35* AnGap-9\n___ 12:20PM BLOOD CK(CPK)-750*\n___ 02:15AM BLOOD CK(CPK)-886*\n___ 12:20PM BLOOD CK-MB-49* MB Indx-6.5* cTropnT-2.81*\n___ 02:15AM BLOOD cTropnT-3.29*\n___ 02:15AM BLOOD CK-MB-69* MB Indx-7.8*\n___ 02:15AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ VIRUS B ANTIBODIES \n Test Result Reference \nRange/Units\n___ B1 AB <1:8 <1:8\n___ B2 AB <1:8 <1:8\n___ B3 AB <1:8 <1:8\n___ B4 AB <1:8 <1:8\n___ B5 AB <1:8 <1:8\n___ B6 AB <1:8 <1:8\n\nINTERPRETIVE CRITERIA:\n <1:8 ANTIBODY NOT DETECTED\n > OR = 1:8 ANTIBODY DETECTED\n\n___ ECHO:\nThe left atrium is normal in size. Left ventricular wall \nthicknesses and cavity size are normal. There is mild regional \nleft ventricular systolic dysfunction with focal hypokinesis of \nthe mid inferior and inferolateral walls. The remaining segments \ncontract normally (LVEF = 45-50%). Transmitral and tissue \nDoppler imaging suggests normal diastolic function, and a normal \nleft ventricular filling pressure (PCWP<12mmHg). Right \nventricular chamber size and free wall motion are normal. The \naortic valve leaflets (3) appear structurally normal with good \nleaflet excursion and no aortic regurgitation. The mitral valve \nappears structurally normal with trivial mitral regurgitation. \nThere is no mitral valve prolapse. The estimated pulmonary \nartery systolic pressure is normal. There is a very small \ninterior pericardial effusion. \n\nIMPRESSION: Mild regional left ventricular systolic dysfunction \nwith small inferior pericardial c/w focal myocarditis (cannot \nfully exclude coronary artery disease).\n\n___ CXR:\nIMPRESSION: No acute cardiopulmonary process\n\n___ CARDIAC MRI:\nImpression: \n1. Normal left ventricular cavity size with mid inferolateral \nand lateral wall hypokinesis. The LVEF was mildly decreased at \n48%. The effective forward LVEF was mildly decreased at 46%. \nIncreased T2 signal in the mid inferolateral and lateral walls \nconsistent with myocardial edema or inflammation. Near \ntransmural areas of focal hyperenhancement in the mid inferior, \ninferolateral, and lateral myocardium and adjacent pericardium, \nconsistent with myocardial scarring/fibrosis. \n2. Normal right ventricular cavity size and systolic function. \nThe RVEF was normal at 54%. \n3. Mild mitral regurgitation. \n4. The indexed diameters of the ascending and descending \nthoracic aorta were normal. The main pulmonary artery diameter \nindex was normal. \n5. Normal coronary artery origins with no evidence of anomalous \ncoronary \narteries, and normal signal characteristics of all visualized \nvessel \nsegments. \nThese findings are consistent with focal myopericarditis. \n\n___ ECG:\nSinus rhythm. Small Q waves in leads II, III, aVF and V5-V6 with \nJ point \nand ST segment elevation. Consider inferolateral myocardial \ninfarction. \nEarly precordial ST segment depression may be reciprocal or \nrepresent \nischemia in the anterior wall. However, at this patient's age \nand with the \nprominent QRS voltages, left ventricular hypertrophy, \ncardiomyopathy, \npericarditis and normal for age are all possible. Clinical \ncorrelation is \nsuggested. No previous tracing available for comparison.\nPatient is a previously healthy ___ year old man who presents \nwith chest pain following URI symptoms found to have diffuse ST \nchanges and positive biomarkers. \n \n# Chest Pain: The patient's symptoms, ECG, and cardiac markers \nwere most likely related to myocarditis with viral precipitant \ngiven recent URI/viral syndrome. The patient had an \nechocardiogram which was also consistent with focal wall motion \nabnormality. He did not have any events on telemetry. He also \nhad a cardiac MRI which was consistent with a focal \nmyopericarditis. The patient's chest pain resolved during his \nhospitalization. He will continue low dose metoprolol for the \npotential of arryhtmias. Also, the patient will followup in \ncardiology clinic to evaluate progression or resolution of the \nfocal wall motion abnormality. The coxackievirus titers were \nnegative. His tox screen was also negative. \n \n#. Pump: The patient had a focal wall motion abnormality \nconsistent with myocarditis. On exam, he was clinically \neuvolemic. \n \n#. Rhythm: The patient remained in sinus rhythm without any \nevents on telemetry."}}
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{'final_diagnoses': ['Viral Myocarditis'], 'procedures': ['none'], 'visit_summary': "Patient is a previously healthy ___ year old man who presents \nwith chest pain following URI symptoms found to have diffuse ST \nchanges and positive biomarkers. \n \n# Chest Pain: The patient's symptoms, ECG, and cardiac markers \nwere most likely related to myocarditis with viral precipitant \ngiven recent URI/viral syndrome. The patient had an \nechocardiogram which was also consistent with focal wall motion \nabnormality. He did not have any events on telemetry. He also \nhad a cardiac MRI which was consistent with a focal \nmyopericarditis. The patient's chest pain resolved during his \nhospitalization. He will continue low dose metoprolol for the \npotential of arryhtmias. Also, the patient will followup in \ncardiology clinic to evaluate progression or resolution of the \nfocal wall motion abnormality. The coxackievirus titers were \nnegative. His tox screen was also negative. \n \n#. Pump: The patient had a focal wall motion abnormality \nconsistent with myocarditis. On exam, he was clinically \neuvolemic. \n \n#. Rhythm: The patient remained in sinus rhythm without any \nevents on telemetry.", 'medications_prescribed': ['Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).\nDisp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'F', 'symptoms': 'change in mental status', 'medical_history': ['___ Lindau', '-cerebellar haemangioblastoma excised ___', '-___ medulla irradiation', '-___ spinal irradiation', '-___ cervical and thoracic spinal tumours excised... residual \nchronic back pain', '-1990s phaeochromocytoma...R adrenalectomy; islet cell tumour \nexcised with spleen and consequent DM', '-___ endolymphatic sac tumour R ear...deaf R ear/balance \nproblems', '-___ Partial R nephrectomy for removal of renal cyst (benign)', '-___ metastatic renal cell carcinoma (R ureteral stent \nreplaced q 4months) assoc with metastatic disease to the brain, \nscalp and lung.', 'Haem-Onc Dr ___.', '-osteoporosis (prev treated with fosamax)', '-GERD', '-DM insulin dependent', '-Migraines', '-HTN last couple months (not on treatment)', '-Appendicectomy', '-Hernia OT'], 'family_history': "Mother CAD and depression; father alzheimer's disease and \ndepression; sister depression/migraines/2 brothers well", 'present_illness': '___ year old man with ___ Lindau disease (with \nnon-functioning pheo s/p right adrenalectomy, pancreatic tail \ntumor, retinal hemangiomas, multiple spine hemangiomas), \nmetastatic renal cell carcinoma (to lungs, scalp and brain)on \nsorafenib trial. \nHe presented to ___ after his sister found him \nnapping at home, confused, not wearing clothing. He had not felt \nwell, had noticed decreased urine and had a fever to 104 1 day \nprior to this and had taken cipro at home. His sister denied \nthat he had complained of vomiting or diarrhea. At ___ \nhe was found to have a fever, UTI (given levo), had a negative \nhead CT and a sodium of 112 so was transferred to ___. There \nwas also a question of right sided weakness which was not \nfurther described. \n.', 'medications': [{'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', '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', 'route': 'PO/NG', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', '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': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': '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': '27.0', 'valuenum': 27.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . estimated GFR (eGFR) is likely between 74 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': 146.0, 'valueuom': 'mg/dL', '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': '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, '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': '28.5', 'valuenum': 28.5, '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': '24.1', 'valuenum': 24.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.0', 'valuenum': 47.0, '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': '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': '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': 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': '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': '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': 4.7, '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': 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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, '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': '30.4', 'valuenum': 30.4, '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': '24.1', 'valuenum': 24.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '371', 'valuenum': 371.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'vs 97.6, HR 104, BP 137/81, 97%2L, RR 23 \ngen pale, lying in bed, speaking in non-sensical sentences \nCV RRR, no murmurs \nPulm CTAB anteriorly \nAbdomen soft, NT \nR.nephrostomy tube insertion site-slightly erythematous \nExtremities no edema \nLines 2 PIV', 'diagnoses': [{'icd_code': 'C7931', 'desc': 'Secondary malignant neoplasm of brain'}, {'icd_code': 'C642', 'desc': 'Malignant neoplasm of left kidney, except renal pelvis'}, {'icd_code': 'C7800', 'desc': 'Secondary malignant neoplasm of unspecified lung'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z803', 'desc': 'Family history of malignant neoplasm of breast'}], 'summary': '___ 09:16PM LACTATE-2.0 NA+-116*\n___ 09:15PM GLUCOSE-148* UREA N-16 CREAT-0.9 SODIUM-115* \nPOTASSIUM-5.5* CHLORIDE-80* TOTAL CO2-23 ANION GAP-18\n___ 09:15PM estGFR-Using this\n___ 09:15PM CORTISOL-46.1*\n___ 09:15PM URINE HOURS-RANDOM\n___ 09:15PM URINE GR HOLD-HOLD\n___ 09:15PM WBC-58.3*# RBC-3.25* HGB-7.3*# HCT-25.6* \nMCV-79* MCH-22.6*# MCHC-28.7* RDW-15.5\n___ 09:15PM NEUTS-82* BANDS-11* LYMPHS-1* MONOS-4 EOS-0 \nBASOS-0 ATYPS-1* METAS-1* MYELOS-0 NUC RBCS-1*\n___ 09:15PM HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-1+ \nMACROCYT-NORMAL MICROCYT-2+ POLYCHROM-1+ BURR-OCCASIONAL \nTEARDROP-OCCASIONAL ACANTHOCY-OCCASIONAL\n___ 09:15PM PLT SMR-VERY HIGH PLT COUNT-831*\n___ 09:15PM URINE COLOR-Straw APPEAR-Hazy SP ___\n___ 09:15PM URINE BLOOD-LG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-MOD\n___ 09:15PM URINE ___ WBC->50 BACTERIA-MANY \nYEAST-MANY EPI-0\n___ 02:05PM BLOOD WBC-50.2* Hct-25.2*\n___ 01:22AM BLOOD Neuts-67 Bands-20* Lymphs-5* Monos-7 \nEos-0 Baso-0 ___ Myelos-1* NRBC-2*\n___ 02:05PM BLOOD Glucose-129* Na-134\n___ 03:46AM BLOOD ALT-14 AST-24 AlkPhos-290* TotBili-0.3\n___ 03:46AM BLOOD Albumin-2.1* Calcium-8.6 Phos-2.7 Mg-2.0\n___ 06:48AM BLOOD TSH-2.9\n___ 06:48AM BLOOD T4-6.5\n___ 08:04AM BLOOD Cortsol-42.2*\n___ year old man with ___ Lindau disease (with \nnon-functioning pheo s/p right adrenalectomy, pancreatic tail \ntumor, retinal hemangiomas, multiple spine hemangiomas), \nmetastatic renal cell carcinoma (to lungs, scalp and brain)on \n___ trial who presented with altered mental status, \nhyponatremia, and right lobar PNA. \n.\nHOSPITAL COURSE BY PROBLEM:\n.\n#Severe Hyponatremia-p/w Na 112 at OSH,trending down since \n___ (acute on chronic). Possible causes considered were: \nadrenal insufficiency (could be primary as he has h/o pheo, or \nsecondary as he has had surgery on his pituitary gland, but this \nwas not evidenced by his presentation or vital signs) as he has \nhad labile BP recently, especially in the setting of \nhyperkalemia, or more likely volume depletion secondary to \ninfection as his exam was consistent with volume depletion. \nOther possible cause was SIADH as he has intracranial processes \nas well as pneumonia. Also, hypothyroidism could be a cause, but \nhis thyroid function tests were all normal. He received 3% NaCl \nto correct his sodium and was started on intravenous \nantibiotics. His sodium improved with these interventions.\n.\n#Change in Mental Status-unclear if from hyponatremia or \ninfection, more worrisome would be intracranial hemorrhage or \nstroke as he has history of this, however he improved with \nantibiotic therapy. \n.\n#right middle lobe pneumonia- sputum culture not obtained, but \nempirically placed on ceftriaxone and levofloxacin IV. His \noxygenation remained adequate on room air and he was largely \nasymptomatic. Blood cx remained negative. Influenza was \nnegative. He will finish a 2 week course of antibiotics\n.\n#?UTI- pt has r nephrostomy tube, u/a concerning for UTI and pt \nplaced on ceftriaxone also for dual coverage of PNA. Cultures \nwere however inconclusive ("mixed urogenital flora").\n.\n#VHL-stable, hemangiomas of retina, spine \n.\n#Renal Cell Ca- on chemotherapy (sorafenib) per Dr. ___, \ncurrently on hold\n.\n#DM-continue home dose of lantus 5 qam and sliding scale \n.\n#Chronic Pain-home doses of Morphine 15 mg po q.8h p.r.n.\n.\n#Hypothyroidism-continue levothyroxine, held briefly during \nhospitalization \n.\n#GERD-protonix \n.\n___ (sister)HCP ___'}}
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{'final_diagnoses': ['pneumonia', '___ Lindau', 'Metastatic Renal Cell Carcinoma', 'Chronic Pain', 'Right nephrostomy tube', 'Constipation'], 'procedures': ['None'], 'visit_summary': '___ year old man with ___ Lindau disease (with \nnon-functioning pheo s/p right adrenalectomy, pancreatic tail \ntumor, retinal hemangiomas, multiple spine hemangiomas), \nmetastatic renal cell carcinoma (to lungs, scalp and brain)on \n___ trial who presented with altered mental status, \nhyponatremia, and right lobar PNA. \n.\nHOSPITAL COURSE BY PROBLEM:\n.\n#Severe Hyponatremia-p/w Na 112 at OSH,trending down since \n___ (acute on chronic). Possible causes considered were: \nadrenal insufficiency (could be primary as he has h/o pheo, or \nsecondary as he has had surgery on his pituitary gland, but this \nwas not evidenced by his presentation or vital signs) as he has \nhad labile BP recently, especially in the setting of \nhyperkalemia, or more likely volume depletion secondary to \ninfection as his exam was consistent with volume depletion. \nOther possible cause was SIADH as he has intracranial processes \nas well as pneumonia. Also, hypothyroidism could be a cause, but \nhis thyroid function tests were all normal. He received 3% NaCl \nto correct his sodium and was started on intravenous \nantibiotics. His sodium improved with these interventions.\n.\n#Change in Mental Status-unclear if from hyponatremia or \ninfection, more worrisome would be intracranial hemorrhage or \nstroke as he has history of this, however he improved with \nantibiotic therapy. \n.\n#right middle lobe pneumonia- sputum culture not obtained, but \nempirically placed on ceftriaxone and levofloxacin IV. His \noxygenation remained adequate on room air and he was largely \nasymptomatic. Blood cx remained negative. Influenza was \nnegative. He will finish a 2 week course of antibiotics\n.\n#?UTI- pt has r nephrostomy tube, u/a concerning for UTI and pt \nplaced on ceftriaxone also for dual coverage of PNA. Cultures \nwere however inconclusive ("mixed urogenital flora").\n.\n#VHL-stable, hemangiomas of retina, spine \n.\n#Renal Cell Ca- on chemotherapy (sorafenib) per Dr. ___, \ncurrently on hold\n.\n#DM-continue home dose of lantus 5 qam and sliding scale \n.\n#Chronic Pain-home doses of Morphine 15 mg po q.8h p.r.n.\n.\n#Hypothyroidism-continue levothyroxine, held briefly during \nhospitalization \n.\n#GERD-protonix \n.\n___ (sister)HCP ___', 'medications_prescribed': ['Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \nHS (at bedtime).', 'Insulin Glargine 100 unit/mL Solution Sig: Five (5) units \nSubcutaneous once a day.', 'Morphine 15 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) \nas needed: hold for sedation or rr< 10.', 'Psyllium Packet Sig: One (1) Packet PO TID (3 times a \nday) as needed for constipation.', 'Nystatin 100,000 unit/mL Suspension Sig: Ten (10) ML PO TID \n(3 times a day) for 10 days.', 'Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily) for 10 days.', '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).', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO once a day.', 'Ceftriaxone-Dextrose (Iso-osm) 2 gram/50 mL Piggyback Sig: \nTwo (2) gm Intravenous Q24H (every 24 hours) for 10 days.', 'Insulin Glargine 100 unit/mL Solution Sig: humalog sliding \nscale Subcutaneous four times a day.', 'Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO once a \nday.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'M', 'symptoms': 'Nausea/vomiting', 'medical_history': ['- Idiopathic gastroparesis since ___, s/p G-tube for gastric \ndecompression (___) and gastric pacer (___). She had her tube \nchanged about 1 week ago and it has been working well. She has \nbeen on a variety of medications related to this diagnosis \nincluding Reglan (metoclopramide), erythromycin, Zelnorm \n(tegaserod), and domperidone with no improvement.', '- History of anorexia about ___ years ago (excess purging \nbehavior).', '- Migraine headaches on nasal Zomig as needed.', '- Osteopenia', '- Lactose intolerance'], 'family_history': 'History of DM and CAD.\nNo family history of fluid or electrolyte abnormalities or renal \ndisease.', 'present_illness': 'Ms. ___ is a ___ woman with longstanding history of \nidiopathic gastroparesis s/p gastric pacer and G-tube for \ngastric decompression and multiple prior admissions for \nhypokalemia, now presenting with 2 days of vomiting and found on \ninitial presentation to have potassium of 1.5.\n.\nShe was in her normal state of health until ___, when she \nexperienced several episodes of diarrhea which self-resolved. On \n___ morning she began to experience severe nausea and \nvomiting, which was significantly more than the nausea she \nusually experiences from gastroparesis. The nausea/vomiting \npersisted into the evening. She describes the emesis as bilious \nand non-bloody, followed by dry heaves. She was unable to stay \nhydrated or take her normal potassium supplements due to the \nseverity of her symptoms. This morning her nausea/vomiting \npersisted and she presented to the ED for further evaluation.\n.\nOf note, she has severe gastroparesis requiring decompression \nvia her G-tube every few days for resolution of nausea. She \ndenies weakness, palpitations or chest pain. No shortness of \nbreath. She has been eating her regular low-fat, low-fiber diet \nwith frequent meals per her norm. No abdominal pain, no recent \nweight loss, no changes in urine frequency or amount.\n.\nShe has had multiple ED visits for severe hypokalemia, most \nrecently on ___. She reports that potassium runs close to 3 \nat baseline despite PO supplementation. She reports good \ncompliance with her PO potassium, despite the esophageal and \nstomach discomfort she associates with it.\n.\nIn the ED, initial vital signs were T 96.6, HR 75, BP 109/66, RR \n20, O2 sat 99%RA. Labs were notable for Na 122, K 1.5 (2.2 \nverified), Cl 59, bicarb >50. She received 40meq KCl via G tube \nas well as another 40meq KCl IV. She also received ondansetron, \npromethazine and diphenhydramine. Upon transfer to the floor, \nshe reports her nausea significantly improved and currently has \nno acute complaints.', 'medications': [{'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'HS', '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': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', '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': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', '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}], 'exams': 'VS: T 97.3, BP 92/64, HR 72, RR 18, SpO2 99RA \nGen: ___ woman appearing younger than her stated age, \nlying in bed in NAD. Alert and oriented. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM. Somewhat \nprominent parotids. Small mouth opening, good dentition.\nNeck: Supple, full ROM. No JVD. No cervical lymphadenopathy. No \ncarotid bruits noted.\nCV: RRR with normal S1, S2. No M/R/G. No S3 or S4.\nChest: Respiration unlabored, no accessory muscle use. CTAB \nwithout crackles, wheezes or rhonchi.\nAbd: Normal bowel sounds. Soft, NT, ND. No organomegaly or \nmasses. G-tube noted in epigastrium. Gastric pacer noted in RLQ.\nExt: WWP. No C/C/E. 2+ pulses in all extremities.\nSkin: Small well-circumscribed area of erythema adjacent to \nG-tube with hyperkeratosis.\nNeuro: CN II-XII grossly intact. Strength ___ in all \nextremities. Normal gait. Normal speech, provides detailed \nhistory.', 'diagnoses': [{'icd_code': '53550', 'desc': 'Unspecified gastritis and gastroduodenitis, without mention of hemorrhage'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '2769', 'desc': 'Electrolyte and fluid disorders not elsewhere classified'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': '7295', 'desc': 'Pain in limb'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}, {'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2273', 'desc': 'Benign neoplasm of pituitary gland and craniopharyngeal duct'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}], 'summary': "On Admission:\n=============\n___ 12:55PM BLOOD WBC-10.2# RBC-4.87 Hgb-15.8 Hct-39.9 \nMCV-82 MCH-32.4* MCHC-39.7*# RDW-12.6 Plt ___\n___ 12:55PM BLOOD Neuts-88.2* Bands-0 Lymphs-7.7* Monos-3.8 \nEos-0.2 Baso-0.2\n___ 12:55PM BLOOD Glucose-121* UreaN-12 Creat-0.4 Na-122* \nK-1.5* Cl-59* HCO3-GREATER TH\n___ 12:55PM BLOOD Calcium-9.9 Phos-2.7 Mg-1.8\n___ 12:55PM BLOOD Osmolal-242*\n___ 10:42PM BLOOD ___ pO2-186* pCO2-51* pH-7.50* \ncalTCO2-41* Base XS-14 Comment-GREEN\n.\nPrior to discharge:\n===================\n___ 07:35AM BLOOD WBC-5.6 RBC-3.87* Hgb-12.3# Hct-35.4* \nMCV-92# MCH-31.8 MCHC-34.8# RDW-12.8 Plt ___\n___ 03:15PM BLOOD Glucose-71 UreaN-7 Creat-0.5 Na-139 \nK-3.2* Cl-93* HCO3-39* AnGap-10\n___ 04:09PM BLOOD ___ pO2-30* pCO2-71* pH-7.35 \ncalTCO2-41* Base XS-9 Comment-GREEN TOP\n.\nStudies pending at the time of discharge:\n=========================================\nDiuretic Screen\nPrimary Reason for Hospitalization: \n===================================\nMs. ___ is a ___ woman with longstanding history of \nidiopathic gastroparesis s/p gastric pacer and G-tube for \ngastric decompression and multiple prior admissions for \nhypokalemia was admitted for monitoring and treatment of severe \nelectrolyte abnormalities, with K noted to be 1.5 in ED. K was \nrepleted aggressively both IV and through her G-tube, and was \n3.2(approximately her baseline) at time of discharge. EKG and \ntelemetry monitoring was initially remarkable for hypokalemic \nchanges including U waves which resolved after K repletion. Na \nwas also noted to be 122 on admission, and improved with IV \nfluids in a matter consistent with volume contraction. The \npatient's nausea was managed with IV antiemetics. At time of \ndischarge she was asymptomatic and denied nausea, vomiting, or \nweakness.\n.\nACTIVE ISSUES:\n===============\n<I># Metabolic alkalosis with hypokalemia: </I> \nMost likely due to loss of KCl and HCl from vomiting from \ngastroenteritis, with secondary contraction alkalosis. Other \netiologies include diuretic abuse, or hereditary \n(___) syndromes. A diuretic screen was sent which \nwill be followed up by her outpatient nephrologist. Her chronic \nhypokalemia is likely due to her draining G-tube with chronic \nloss of KCL and HCl. The patient is normally able to keep her \npotassium around 3.0 by taking potassium powder PO and eating a \nhigh potassium diet. However the viral gastroenteritis \nsuperimposed upon her chronic issues were likely the reason for \nher profound hypokalemia on presentation. She and her mother \nwere already very educated on the symptoms of low potassium and \non foods with high potassium. Most likely this will continue to \nbe a problem for Ms. ___ as long as she has her G-tube \ndraining frequently. This was discussed with the patient however \nthe G-tube decompression has made a huge difference in her \nquality of life from gastroparesis and therefore the benefits \nseem to outweigh the risk of continued need for high potassium \nsupplementation. She will increase her potassium supplementation \nfrom 40meq daily to 60meq daily and continue high potassium \ndiet. \n-- She will follow-up with PCP for regular electrolyte checks. \n.\n<I># Gastroenteritis:</I> Most likely this is viral given \npresentation. At least one sick contact at home/work with \nsimilar symptoms of diarrhea/vomiting that resolved. Nausea \nimproved on antiemetics. \n-- She was given a prescription for promethazine suppository for \nuse in the future when she has intractable vomiting to help \nprevent episodes like this one. \n.\n<I># Gastroparesis:</I> \nLongstanding, idiopathic. S/p Gastric pacemaker and G-tube for \ngastric decompression\n-- She will follow-up with her outpatient gastroenterologist\n.\nTRANSITIONAL ISSUES:\n====================\n-- Diuretic Screen still pending at discharge. To be followed up \nby patient's nephrologist.\n-- She should chem-7 checked in the next week to ensure adequate \npotassium supplementation. Consider increasing to 80meq or more \nif neccessary. She will likely need regular potassium checks in \nthe short term."}}
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{'final_diagnoses': ['- Gastroenteritis', '- Hypokalemia', '- Metabolic Alkalosis', '- Hyponatremia', '- Idiopathic Gastroparesis'], 'procedures': ['None'], 'visit_summary': "Primary Reason for Hospitalization: \n===================================\nMs. ___ is a ___ woman with longstanding history of \nidiopathic gastroparesis s/p gastric pacer and G-tube for \ngastric decompression and multiple prior admissions for \nhypokalemia was admitted for monitoring and treatment of severe \nelectrolyte abnormalities, with K noted to be 1.5 in ED. K was \nrepleted aggressively both IV and through her G-tube, and was \n3.2(approximately her baseline) at time of discharge. EKG and \ntelemetry monitoring was initially remarkable for hypokalemic \nchanges including U waves which resolved after K repletion. Na \nwas also noted to be 122 on admission, and improved with IV \nfluids in a matter consistent with volume contraction. The \npatient's nausea was managed with IV antiemetics. At time of \ndischarge she was asymptomatic and denied nausea, vomiting, or \nweakness.\n.\nACTIVE ISSUES:\n===============\n<I># Metabolic alkalosis with hypokalemia: </I> \nMost likely due to loss of KCl and HCl from vomiting from \ngastroenteritis, with secondary contraction alkalosis. Other \netiologies include diuretic abuse, or hereditary \n(___) syndromes. A diuretic screen was sent which \nwill be followed up by her outpatient nephrologist. Her chronic \nhypokalemia is likely due to her draining G-tube with chronic \nloss of KCL and HCl. The patient is normally able to keep her \npotassium around 3.0 by taking potassium powder PO and eating a \nhigh potassium diet. However the viral gastroenteritis \nsuperimposed upon her chronic issues were likely the reason for \nher profound hypokalemia on presentation. She and her mother \nwere already very educated on the symptoms of low potassium and \non foods with high potassium. Most likely this will continue to \nbe a problem for Ms. ___ as long as she has her G-tube \ndraining frequently. This was discussed with the patient however \nthe G-tube decompression has made a huge difference in her \nquality of life from gastroparesis and therefore the benefits \nseem to outweigh the risk of continued need for high potassium \nsupplementation. She will increase her potassium supplementation \nfrom 40meq daily to 60meq daily and continue high potassium \ndiet. \n-- She will follow-up with PCP for regular electrolyte checks. \n.\n<I># Gastroenteritis:</I> Most likely this is viral given \npresentation. At least one sick contact at home/work with \nsimilar symptoms of diarrhea/vomiting that resolved. Nausea \nimproved on antiemetics. \n-- She was given a prescription for promethazine suppository for \nuse in the future when she has intractable vomiting to help \nprevent episodes like this one. \n.\n<I># Gastroparesis:</I> \nLongstanding, idiopathic. S/p Gastric pacemaker and G-tube for \ngastric decompression\n-- She will follow-up with her outpatient gastroenterologist\n.\nTRANSITIONAL ISSUES:\n====================\n-- Diuretic Screen still pending at discharge. To be followed up \nby patient's nephrologist.\n-- She should chem-7 checked in the next week to ensure adequate \npotassium supplementation. Consider increasing to 80meq or more \nif neccessary. She will likely need regular potassium checks in \nthe short term.", 'medications_prescribed': ['1. promethazine 12.5 mg Suppository Sig: ___ Rectal every six \n(6) hours as needed for nausea.\nDisp:*30 tabs* Refills:*0*', '2. potassium chloride 20 mEq Packet Sig: Three (3) PO once a \nday: 60 meq divided up over the day. .\nDisp:*90 packets* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'chest pain', 'medical_history': ['Thymoma - s/p L VATS mediastinal bx (___), s/p radical\nthymectomy w LN dissection ___', 'S/p lap ccy ___', 'S/p hemorrhoids', 'Low back pain'], 'family_history': 'Father with HTN, DM, hydrocephalus requiring shunt placement.\nMother is healthy. Family history of lung cancer in several\nrelatives. No family history of rheumatologic disease.', 'present_illness': '___ w/PMHx thymoma resection, w/prior L pleural empyema, s/p L \nVATS with washout presents with complaint of subcostal chest \npain. Notably, the patient has a history of a positive ___ and \npositive anti-Ro antibody, thought due to an underlying \nconnective tissue/SLE disease. She has been on prednisone 20 mg \nwhich was recently increased to 60 mg without relief of symptoms \nand is presently followed by rheumatology. At a recent visit \nwith rheum on ___, she was noted to have no improvement with \nprednisone and has started on a taper. She was also advised to \nf/u in pain clinic for possible intercostal nerve block or other \nintervention for her chronic chest pain. She had a CT chest on \n___ which showed complete resolution of bil pleural and \npericardial effusions.\nShe presents tonight with a pain in her chest which is different \nfrom her chronic chest pain; her usual pain is on her left side \nhowever this pain starts in the epigastric area, just below the \nrib cage, radiating up to her chest and her neck and also \nassociated with the headache. when the pain comes on it feels \nhard to breathe. It is also associated with tenderness to \npalpation. This particular pain started happening about 2 weeks \nago, and had been going away quickly. 3 days ago it lasted 15 \nminutes and today it was more severe and lasted longer. this \nworsened at 1045 tonight waking the patient from her attempt to \nsleep.\nIn the ED initial VS were 97.7 95 120/89 16 100%. EKG showed SR \n@ 93, NA, NI, NSSTW. CXR showed no acute process. She received \nIV dilaudid in ED and was admitted for pain control to medicine \nservice.\nOn arrival to the floor, pain is now resolved and denies any \nshortness of breath.', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '266', 'valuenum': 266.0, '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': '4.94', 'valuenum': 4.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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}], 'exams': '98 139/91 105 20 100% RA\nGENERAL - well-appearing 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, no MRG, nl S1-S2\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)\nSKIN - no rashes or lesions\nLYMPH - no cervical, axillary, or inguinal LAD\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout', 'diagnoses': [{'icd_code': '936', 'desc': 'Foreign body in intestine and colon'}, {'icd_code': 'E915', 'desc': 'Foreign body accidentally entering other orifice'}, {'icd_code': 'E8499', 'desc': 'Accidents occurring in unspecified place'}, {'icd_code': '5300', 'desc': 'Achalasia and cardiospasm'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '49300', 'desc': 'Extrinsic asthma, unspecified'}], 'summary': '___ 12:38AM BLOOD WBC-9.7 RBC-4.60 Hgb-13.2 Hct-40.9 MCV-89 \nMCH-28.8 MCHC-32.4 RDW-15.9* Plt ___\n___ 12:38AM BLOOD Neuts-73.7* ___ Monos-5.6 Eos-0.8 \nBaso-0.2\n___ 12:38AM BLOOD ___ PTT-25.3 ___\n___ 12:38AM BLOOD Glucose-104* UreaN-22* Creat-0.8 Na-140 \nK-4.1 Cl-102 HCO3-28 AnGap-14\n___ 12:38AM BLOOD cTropnT-<0.01\n___ 09:00AM BLOOD cTropnT-<0.01\n___ 12:43AM BLOOD Lactate-1.8\n\nChest X-ray:\n\nPA and lateral chest radiographs were obtained. The lungs are \nwell expanded\nand clear. There is no focal consolidation, effusion or \npneumothorax. \nMediastinal clips and median sternotomy wires are in expected \npositions.\n\nIMPRESSION:\n\nNo acute cardiopulmonary process.\n___ w/PMHx thymoma resection, w/prior L pleural empyema, s/p L \nVATS with washout presents with complaint of epigastric pain.\n\n# epigastric pain: The patient presented with epigastric pain \nthat radiated substernally associated with headache and otalgia. \n Given normal chest x-ray and negative trop x 2, the pain was \nfelt to be non-cardiac and non-pulmonary in origin. She also \nhad a chest CTA performed 5 days prior to admission that \ndemonstrated resolved pleural and cardiac effusion and no \nevidence of PE. Ultimately the exact etiology of her chest pain \nwas unclear, but most consistent with GERD/dyspesia given the \npain radiated from her epigastric region and was worse with \nlying flat. She was started on omeprazole. The patient should \nfollow up with her PCP and pain clinic for further evaluation \nand management of her chest pain. \n\n# anxiety/insomnia: Her home doses of amitryptiline and \nlorazepam were continued'}}
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{'final_diagnoses': ['dyspepsia'], 'procedures': ['none'], 'visit_summary': '___ w/PMHx thymoma resection, w/prior L pleural empyema, s/p L \nVATS with washout presents with complaint of epigastric pain.\n\n# epigastric pain: The patient presented with epigastric pain \nthat radiated substernally associated with headache and otalgia. \n Given normal chest x-ray and negative trop x 2, the pain was \nfelt to be non-cardiac and non-pulmonary in origin. She also \nhad a chest CTA performed 5 days prior to admission that \ndemonstrated resolved pleural and cardiac effusion and no \nevidence of PE. Ultimately the exact etiology of her chest pain \nwas unclear, but most consistent with GERD/dyspesia given the \npain radiated from her epigastric region and was worse with \nlying flat. She was started on omeprazole. The patient should \nfollow up with her PCP and pain clinic for further evaluation \nand management of her chest pain. \n\n# anxiety/insomnia: Her home doses of amitryptiline and \nlorazepam were continued', 'medications_prescribed': ['Amitriptyline 25 mg PO HS', 'Docusate Sodium 100 mg PO BID:PRN constipation', 'HYDROmorphone (Dilaudid) 4 mg PO Q6H:PRN pain', 'Lorazepam 0.5 mg PO HS:PRN anxiety', 'PredniSONE 40 mg PO DAILY', 'Senna 1 TAB PO BID:PRN constipation', 'Acetaminophen 325-650 mg PO Q6H:PRN pain', 'Omeprazole 20 mg PO DAILY', 'RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 69, 'gender': 'M', 'symptoms': 'Fever/chills', 'medical_history': ['HTN', 'pseudogout', 'diabetes'], 'family_history': 'non-contributory', 'present_illness': '___ who underwent prostate needle biopsy ___ presented to \nED with ~12h h/o low grade fever, chills, and rigors. He denies \nN/V, dysuria, hematuria.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID', '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': 'Pneumococcal Vac Polyvalent', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, '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': '1.10', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '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': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '295', 'valuenum': 295.0, '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': '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': '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': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 60 if non African-American (mL/min/1.73 m2). Estimated GFR = 73 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', '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': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '73', 'valuenum': 73.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, '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': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'WdWn male, nad, pleasant demeanor and affect\nWife at bedside\n___\nAbdomen benign\nExtremities w/out edema', 'diagnoses': [{'icd_code': '185', 'desc': 'Malignant neoplasm of prostate'}, {'icd_code': '28419', 'desc': 'Other pancytopenia'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': '___ 08:45AM BLOOD WBC-8.9\n___ 05:16AM BLOOD WBC-11.6* RBC-4.54* Hgb-15.6 Hct-44.3 \nMCV-98 MCH-34.4* MCHC-35.3* RDW-12.4 Plt Ct-92*\n___ 05:00PM BLOOD WBC-13.4*# RBC-5.07 Hgb-17.3 Hct-50.3 \nMCV-99* MCH-34.1* MCHC-34.4 RDW-13.0 Plt ___\n___ 08:45AM BLOOD Glucose-171* UreaN-19 Creat-0.9 Na-137 \nK-4.2 Cl-103\n___ 05:16AM BLOOD Glucose-133* UreaN-24* Creat-1.0 Na-135 \nK-4.5 Cl-102 HCO3-20* AnGap-18\n___ 08:45AM BLOOD Calcium-9.9 Mg-2.2\n\n___ 9:07 am STOOL CONSISTENCY: LOOSE Source: \nStool. \n **FINAL REPORT ___\n CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final ___: \n Feces negative for C.difficile toxin A & B by EIA. \n (Reference Range-Negative). \n\n___ 7:04 pm URINE Site: NOT SPECIFIED\n **FINAL REPORT ___\n URINE CULTURE (Final ___: NO GROWTH. \n\n___ 5:00 pm BLOOD CULTURE\n Blood Culture, Routine (Pending): \nMr. ___ is a very pleasant ___ who underwent prostate needle \nbiopsy yesterday presents to ED with ~12h h/o low grade fever, \nchills, and rigors. He denies N/V, dysuria, hematuria. He was \nadmitted for observation and IV antibiotics pending cultures. He \nwas maintained on his home medications and discharged hospital \nday two without fever, voiding w/out difficulty and tolerating a \nregular diet. He was given antibiotics to continue with the \nunderstanding the final blood cultures were still pending. All \nof his questions were answered.'}}
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{'final_diagnoses': ['Fever/chills s/p needle prostate biopsy'], 'procedures': ['None during this admission'], 'visit_summary': 'Mr. ___ is a very pleasant ___ who underwent prostate needle \nbiopsy yesterday presents to ED with ~12h h/o low grade fever, \nchills, and rigors. He denies N/V, dysuria, hematuria. He was \nadmitted for observation and IV antibiotics pending cultures. He \nwas maintained on his home medications and discharged hospital \nday two without fever, voiding w/out difficulty and tolerating a \nregular diet. He was given antibiotics to continue with the \nunderstanding the final blood cultures were still pending. All \nof his questions were answered.', 'medications_prescribed': ['acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain, fever >99.', 'metformin 500 mg Tablet Extended Release 24 hr Sig: One (1) \nTablet Extended Release 24 hr PO QAM (once a day (in the \nmorning)).', 'gabapentin 100 mg Capsule Sig: Two (2) Capsule PO BID (2 \ntimes a day).', 'allopurinol ___ mg Tablet Sig: Two (2) Tablet PO QAM (once a \nday (in the morning)).', 'allopurinol ___ mg Tablet Sig: One (1) Tablet PO QPM (once a \nday (in the evening)).', 'benazepril Oral', 'cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO Q12H (every \n12 hours) for 7 days.\nDisp:*14 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': 74, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['Bilateral ulnar neuropathy from boxing', 'Ulnar nerve release, carpal tunnel release', 'Anxiety', 'OCD', 'Depression', 'PTSD'], 'family_history': '-Lung Cancer: father died at ___ of lung cancer (heavy smoker). 1 \nuncle died of lung cancer in ___. \n-Pancreatic cancer: grandmother, aunt, and 1 uncle all died of \npancreatic cancer. (Uncle was in his ___.\n. ', 'present_illness': 'HPI: Pt is a ___ with anxiety disorder, depression, chronic \nalcohol use, who presents with worsening RUQ pain. Pt w/RUQ pain \nx months, worse x 1d. Pt was seen at ___ on \n___, and they did cardiac workup which was negative, and pt \nwas discharged to ___ for detox. He received multiple doses \nof Lorazepam there. He had worsening abdominal pain today at \n___ and sent here for further eval. At ___ for \ndual diagnosis bed, reports drinking binge x several days, last \ndrink ~48hrs PTA ___ at 1700). He said that he has been \ndrinking quart vodka per day. He has had been hospitalized for \nwithdrawal previously, but denies seizures. The RUQ pain has \nbeen going on for months, and then got progressively worse, \nsevere ___, no radiation, sharp, nausea and emesis "white \nbubbly with black like charcoal." He also had dark, black, \ndiarrhea. Denies fevers or chills. \n. \nIn the ED, initial VS: 97.8 87 135/78 15 100% 2L. Exam showed \nnegative guaiac. Labs showed ALT 58, AST normal, Lipase 104, WBC \n6.3 without left shift, Hct 34 (Baseline 42). Serum & urine tox \npositive for benzos, no alcohol. Lytes wnl. RUQ u/s 1. Markedly \nlimited study. 2. Echogenic liver which may be due to fatty \ninfiltration, though cirrhosis or fibrosis is not excluded. \nFocal areas within the liver which are hypoechoic are \nindeterminate and may represent fatty sparing, but an MRI should \nbe performed to better evaluate these findings. 3. Mild \ngallbladder wall thickening, which could reflect underlying \nhepatic dysfunction. No gallstones or other signs to suggest \ncholecystitis. UA was negative. Surgery was consulted, and given \nno gallstones seen, recommended no acute intervention. He was \ngiven 2 doses of 4mg morphine, given 1mg dilaudid iv for pain.\n.\nVS prior to transfer ___. \n.\nPt states that he is on ___ from ___, and requires 1:1 \nsitter. Pt states that this was because he didn\'t like being \nalone when he was sick and asked for sitter. States that he was \nnever suicidal.\n. \nCurrently, pt with continued RUQ pain, only mildly improved. He \ndenies hallucinations. He said he got Librium at ___.', 'medications': [{'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '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': '372', 'valuenum': 372.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.5', 'valuenum': 47.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 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': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '577', 'valuenum': 577.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '818', 'valuenum': 818.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS - Tm 97.4, Tc 97.0, BP 114-136 / 72-90, HR 78-86, RR ___, \nSat 95% RA.\nBladder scan > 1L, foley -> 975mL\nGENERAL - anxious, appears mildly uncomfortable, appropriate \nHEENT - NC/AT, PERRLA, slight horizontal nystagmus to extremes \nof gaze, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, diffusely tender to palpation, no rebound, \npoints to RUQ.\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, \nDPs), slight tremor in hands to extension \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, moving all \nextremities \n.\nDISCHARGE PHYSICAL EXAM:\nVS - T 97.9 BP 138/80 P 77 R 20 S 99%RA \nGENERAL - middle-aged heavyset man, no acute distress \nHEENT - PERRL, EOMI, moist mucous membranes \nNECK - supple, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - RRR, no MRG, nl S1-S2 \nABDOMEN - normal bowel sounds, inconsistent tenderness on exam, \nsometimes RUQ v. RLQ. Occasional voluntary guarding. \nEXTREMITIES - no edema, 2+ pulses radial and dp, no tremors \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, moving all \nextremities ', 'diagnoses': [{'icd_code': 'C569', 'desc': 'Malignant neoplasm of unspecified ovary'}, {'icd_code': 'R180', 'desc': 'Malignant ascites'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'R062', 'desc': 'Wheezing'}, {'icd_code': 'C786', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C779', 'desc': 'Secondary and unspecified malignant neoplasm of lymph node, unspecified'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z85820', 'desc': 'Personal history of malignant melanoma of skin'}], 'summary': "___ 08:00PM BLOOD WBC-6.3 RBC-3.97* Hgb-12.6* Hct-34.3* \nMCV-87 MCH-31.6 MCHC-36.6* RDW-12.7 Plt ___\n___ 08:00PM BLOOD Neuts-62.7 ___ Monos-4.5 Eos-1.6 \nBaso-0.8\n___ 08:00PM BLOOD Glucose-112* UreaN-8 Creat-0.9 Na-137 \nK-3.5 Cl-102 HCO3-24 AnGap-15\n___ 08:00PM BLOOD ALT-58* AST-33 AlkPhos-75 TotBili-0.2\n___ 08:00PM BLOOD Lipase-104*\n___ 06:58AM BLOOD Calcium-9.1 Phos-4.4 Mg-2.1\n___ 08:00PM BLOOD Albumin-4.2\n___ 08:00PM BLOOD VitB12-526 Folate-14.5\n___ 08:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-POS Barbitr-NEG Tricycl-NEG\n___ 08:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 08:00PM URINE Color-Straw Appear-Clear Sp ___\n___ 08:00PM URINE bnzodzp-POS barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\n___ CULTURE-FINAL < 10k colonies.\n\n___ RadiologyLIVER OR GALLBLADDER US\n1. Markedly limited study. 2. Echogenic liver which may be due \nto fatty infiltration, though cirrhosis or fibrosis is not \nexcluded. Focal areas within the liver which are hypoechoic are \nindeterminate and may represent fatty sparing, but an MRI should \nbe performed to better evaluate these findings. 3. Mild \ngallbladder wall thickening, which could reflect underlying \nhepatic dysfunction. No gallstones or other signs to suggest \ncholecystitis. \n\n___ RadiologyMRI ABDOMEN W/O & W/CON\n1. Normal-appearing pancreas without evidence of acute or \nchronic pancreatitis. Dual drainage of the pancreatic duct \nthrough a duct of Wirsung and the duct of Santorini is noted. \n2. Markedly fatty liver without concerning lesion. Areas on \nultrasound were areas of focal fatty sparing. \nASSESSMENT & PLAN: Pt is a ___ with anxiety disorder, \ndepression, chronic alcohol use, who presents with worsening RUQ \npain. \n. \n# RUQ pain: DDx includes cholecystitis vs. cholelithiasis vs. \nhepatitis vs. pancreatitis. Most likely pancreatitis give recent \nalcohol binge and lipsae elevated, epigastric tenderness. U/S \nwithout evidence of cholecystitis and no gallstones seen. \nPancreatitis most likely ___ alcohol given heavy alcohol history \nand recent binge drinking. No evidence of gallstones on RUQ u/s. \nOther less likely etiologies include hypercalcemia, medications, \nor hypertriglyceridemia. Unclear significance of hypodense \nlesions observed on US, but given strong family history of \npancreatic cancer, ordered MRI of abdomen to r/o liver \npathology. MRI showed - fatty liver, no acute process, normal \nbiliary system and pancreas. Pt was made NPO on admission and \ntreated with aggressive hydration with IVF. Pt's pain and nausea \nwere treated with ondansetron and morphine, and later tylenol \n(see below for concerns about malingering). Pt was advanced to \nclears ___. He was seen by GI who did not feel he warrented an \nupper endoscopy given his poorly localized and inconsistent exam \nfindings. He is to follow up with hepatology as an outpatient \nfor his hepatosteatosis. \n. \n# Alcohol abuse: Pt with past history of alcohol use. Last drink \n48hrs prior to admission. Currently without s/s withdrawal. Pt \nhad benzos positive and received Librium at ___. On ___, \nwas able to obtain more information from ___ ___. \nNurse states that Pt was accepted to ___ on ___, after \nbeing sent from ___. Pt was initially arrested by police \nfor being in a drunken altercation. He then suddenly elicited \nchest pain and was taken to the ED rather than jail. Nurse \nstates that he was not suicidal at ___ and did not have a \nsitter. States that he threatened to overdose ___ years ago and \nalso treatened to hang himself in an ED 2 months prior to ED. At \n___, Pt was on a librium (chloradiazepoxide) scale. Per \nnurse, Pt's outpatient meds were luvox (fluovoxamine 200mg qam \nand 100mg qhs, anafranil (clomipramine) 225mg bid, buspirone \n10mg tid, aripiprazole 15mg qam, gabapentin 800mg tid, and \nquetiapine 600mg qhs. ___ discontinued Pt's quetiapine. Pt's \nstated pharmacy has no record of him. Labs at ___ - ALT 88, \nAST 43. Pt was initially treated with IV fluids, thiamine, MVI, \nfolic acid, and put on CIWA scale w/ diazepam 5mg PRN CIWA >10 \nq2hrs. However, Pt requested high total doses of benzos in \naddition to high total doses morphine. Given concerns about \npotential malingering, along with Pt's behavior (being very \nsedated during exam but still voicing 10+/10 pain and \ninconsistent abdominal exam), Pt's diazepam was reduced to 5mg \nq8hrs.\n. \n# Anemia: Normocytic. pt with Hct 34, reportedly black stools \nand coffee ground emesis, though guaiac negative in ED. Possibly \nalso ___ ACD vs. BMS from alcohol abuse. B12 and folate were \nnormal. Concerning for UGIB given dark black appearance. GI \nservice was consulted, who felt that he did not warrant an upper \nendoscopy given his inconsistent exam and poorly localizing \nsymptoms. He was started on a PPI bid, which he should continue \nat this time.\n.\n# Urinary retention: > 1L on bladder scan on admission, 950mL on \nfoley placement. Pt states that he has had intermittent problems \nwith urine retention and has seen a urologist in the past but is \nnot on any meds. Pt's foley was initially discontinued on ___, \nhowever he did not spontaneously void and bladder scan revealed \n1500 mL. A foley was reinserted at that time. The following \nday, it was discontinued and he was able to void spontaneously.\n.\n# Constipation: Patient noted that he had not had many bowel \nmovements during this hospitalization. He was started on a \nbowel regimen that he should continue as needed should he \ncontinue to experience constipation going forward. \n. \n# Psych: unclear diagnosis, but pt currently at ___ for dual \ndiagnoses and has a h/o past suicide attempts. He currently \ndenies any active SI or HI. Listed as severe depression with \npsychosis per OSH records.\n="}}
|
{'final_diagnoses': ['Abdominal pain', 'Alcohol abuse.'], 'procedures': ['None'], 'visit_summary': "ASSESSMENT & PLAN: Pt is a ___ with anxiety disorder, \ndepression, chronic alcohol use, who presents with worsening RUQ \npain. \n. \n# RUQ pain: DDx includes cholecystitis vs. cholelithiasis vs. \nhepatitis vs. pancreatitis. Most likely pancreatitis give recent \nalcohol binge and lipsae elevated, epigastric tenderness. U/S \nwithout evidence of cholecystitis and no gallstones seen. \nPancreatitis most likely ___ alcohol given heavy alcohol history \nand recent binge drinking. No evidence of gallstones on RUQ u/s. \nOther less likely etiologies include hypercalcemia, medications, \nor hypertriglyceridemia. Unclear significance of hypodense \nlesions observed on US, but given strong family history of \npancreatic cancer, ordered MRI of abdomen to r/o liver \npathology. MRI showed - fatty liver, no acute process, normal \nbiliary system and pancreas. Pt was made NPO on admission and \ntreated with aggressive hydration with IVF. Pt's pain and nausea \nwere treated with ondansetron and morphine, and later tylenol \n(see below for concerns about malingering). Pt was advanced to \nclears ___. He was seen by GI who did not feel he warrented an \nupper endoscopy given his poorly localized and inconsistent exam \nfindings. He is to follow up with hepatology as an outpatient \nfor his hepatosteatosis. \n. \n# Alcohol abuse: Pt with past history of alcohol use. Last drink \n48hrs prior to admission. Currently without s/s withdrawal. Pt \nhad benzos positive and received Librium at ___. On ___, \nwas able to obtain more information from ___ ___. \nNurse states that Pt was accepted to ___ on ___, after \nbeing sent from ___. Pt was initially arrested by police \nfor being in a drunken altercation. He then suddenly elicited \nchest pain and was taken to the ED rather than jail. Nurse \nstates that he was not suicidal at ___ and did not have a \nsitter. States that he threatened to overdose ___ years ago and \nalso treatened to hang himself in an ED 2 months prior to ED. At \n___, Pt was on a librium (chloradiazepoxide) scale. Per \nnurse, Pt's outpatient meds were luvox (fluovoxamine 200mg qam \nand 100mg qhs, anafranil (clomipramine) 225mg bid, buspirone \n10mg tid, aripiprazole 15mg qam, gabapentin 800mg tid, and \nquetiapine 600mg qhs. ___ discontinued Pt's quetiapine. Pt's \nstated pharmacy has no record of him. Labs at ___ - ALT 88, \nAST 43. Pt was initially treated with IV fluids, thiamine, MVI, \nfolic acid, and put on CIWA scale w/ diazepam 5mg PRN CIWA >10 \nq2hrs. However, Pt requested high total doses of benzos in \naddition to high total doses morphine. Given concerns about \npotential malingering, along with Pt's behavior (being very \nsedated during exam but still voicing 10+/10 pain and \ninconsistent abdominal exam), Pt's diazepam was reduced to 5mg \nq8hrs.\n. \n# Anemia: Normocytic. pt with Hct 34, reportedly black stools \nand coffee ground emesis, though guaiac negative in ED. Possibly \nalso ___ ACD vs. BMS from alcohol abuse. B12 and folate were \nnormal. Concerning for UGIB given dark black appearance. GI \nservice was consulted, who felt that he did not warrant an upper \nendoscopy given his inconsistent exam and poorly localizing \nsymptoms. He was started on a PPI bid, which he should continue \nat this time.\n.\n# Urinary retention: > 1L on bladder scan on admission, 950mL on \nfoley placement. Pt states that he has had intermittent problems \nwith urine retention and has seen a urologist in the past but is \nnot on any meds. Pt's foley was initially discontinued on ___, \nhowever he did not spontaneously void and bladder scan revealed \n1500 mL. A foley was reinserted at that time. The following \nday, it was discontinued and he was able to void spontaneously.\n.\n# Constipation: Patient noted that he had not had many bowel \nmovements during this hospitalization. He was started on a \nbowel regimen that he should continue as needed should he \ncontinue to experience constipation going forward. \n. \n# Psych: unclear diagnosis, but pt currently at ___ for dual \ndiagnoses and has a h/o past suicide attempts. He currently \ndenies any active SI or HI. Listed as severe depression with \npsychosis per OSH records.\n=", 'medications_prescribed': ['1. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) \nunit PO DAILY (Daily) as needed for constipation. ', '2. buspirone 10 mg Tablet Sig: Three (3) Tablet PO TID (3 times \na day). ', '3. fluvoxamine 50 mg Tablet Sig: Four (4) Tablet PO QAM (once a \nday (in the morning)). ', '4. fluvoxamine 50 mg Tablet Sig: Two (2) Tablet PO qpm. ', '5. aripiprazole 15 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '6. clomipramine 25 mg Capsule Sig: Nine (9) Capsule PO BID (2 \ntimes a day). ', '7. quetiapine 100 mg Tablet Sig: Six (6) Tablet PO HS (at \nbedtime). ', '8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', '9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation. ', '10. gabapentin 400 mg Capsule Sig: Two (2) Capsule PO TID (3 \ntimes a day). ', '11. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain: Do not exceed 2 grams daily. ', '12. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). ', '13. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '14. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '15. multivitamin with iron 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': 87, 'gender': 'F', 'symptoms': 'Tachycardia', 'medical_history': ['Hypertension', 'Gout', 'Hypothyroidism', 'Hyperlipidemia'], 'family_history': 'She notes a brother who died of a heart attack at the age of ___ \nalmost ___.', 'present_illness': "Ms. ___ is an ___ y/o female with a hitory of hypertension \nand CHF who was sent to the ED by her visiting nurse for \ntachycardia. The patient wsa being evaluated by her ___ when she \nwas noted to have a HR in the low 100's. The patient apparently \nhas been without her metoprolol the last couple of days because \nshe is having a problem with the pharmacy. She reports \npalpitations but denies any significant pain. She denies any \nshortness of breath. \n\nIn the ED, initial VS were: 98.6 96 161/51 97% RA. She was given \na dose of metoprolol and was noted to have a positive U/A \ntherefore was given nitrofurantoin. Her potassium was also noted \nto be 2.3 therefore she was given potassium repletion 40mEq POx2 \nand 40mEq IVx1 which improved to 3.9. \nShe was then noted to have some hypoxia on ambulation with a sat \nof 89%. CXR obtained revealed pulm effusions bilaterally. She \nwas given a dose of levaquin. \n\nOn arrival to the floor, the patient was comfortable and in NAD. \nShe denied having any shortness of breath or palpitations.", 'medications': [{'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aquaphor Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAM\nVS - Temp F 98.2, BP 174/57, HR 94, 98 O2-sat % RA \nGENERAL - elderly female comfortable, appropriate \nHEENT - MMM, OP clear \nNECK - supple, no thyromegaly, no JVD \nLUNGS - CTAB, no wheezes or rhonchi \nHEART - RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout \n\nDischarge PE:\nVS - Temp 98.1, Tm 98.7, BP 140-180s/60-70s, HR 70-80s, O2-sat \n96-100% RA \nI/O: ___\nGENERAL - elderly female, comfortable, appropriate, lying in bed \nin NAD \nHEENT - MMM, OP clear \nNECK - supple, no JVD \nLUNGS - CTAB, no rales or rhonchi\nHEART - RRR, no MRG, nl S1-S2 \nABDOMEN - soft, NT, ND, +BS\nEXTREMITIES - WWP, no ___ edema \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, grossly intact', 'diagnoses': [{'icd_code': '45981', 'desc': 'Venous (peripheral) insufficiency, unspecified'}, {'icd_code': '70719', 'desc': 'Ulcer of other part of lower limb'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '71690', 'desc': 'Arthropathy, unspecified, site unspecified'}], 'summary': "___ 01:21PM BLOOD WBC-12.5* RBC-4.48 Hgb-13.1 Hct-39.2 \nMCV-87 MCH-29.2 MCHC-33.5 RDW-12.7 Plt ___\n___ 01:21PM BLOOD Neuts-87.1* Lymphs-6.9* Monos-5.6 Eos-0.2 \nBaso-0.3\n___ 01:21PM BLOOD Glucose-200* UreaN-20 Creat-1.3* Na-136 \nK-2.3* Cl-91* HCO3-32 AnGap-15\n___ 01:21PM BLOOD Calcium-9.8 Phos-2.8 Mg-1.6\n\nMICROBIOLOGY: \nBlood Culture ___: pending\nUrine culture ___: <10,000 organisms/ml. \n\nIMAGING:\nCXR ___:\nThere is mild cardiomegaly. Small bilateral pleural effusions \nassociated with adjacent atelectasis that are larger on the left \nside. There is no\npneumothorax.\n\nCXR with L lat decub ___:\nThere is mild cardiomegaly. The mediastinal contours are \nunchanged. Small\nbilateral pleural effusions larger on the left side with \nassociated minimal\natelectasis left greater than right are again visualized. There \nare no new\nlung abnormalities.\n\nDISCHARGE LABS:\n___ 07:15AM BLOOD WBC-11.4* RBC-4.60 Hgb-13.7 Hct-40.9 \nMCV-89 MCH-29.8 MCHC-33.5 RDW-13.0 Plt ___\n___ 07:15AM BLOOD Glucose-107* UreaN-17 Creat-1.2* Na-137 \nK-3.6 Cl-97 HCO3-30 AnGap-14\n___ 07:15AM BLOOD Calcium-9.1 Phos-3.0 Mg-2.___\nwith h/o HTN, HLD who was sent to the ED by her visiting \nnurse for tachycardia and found to have ambulatory hypoxia. \n.\n>> Active issues:\n# Ambulatory Hypoxia: Patient was noted to be hypoxic on \nambulation when in the ED to 89%. Pt was without hypoxia at rest \nsatting 98-100% RA and generally without complaints of dyspnea. \nHer lungs were clear to auscultation. The etiology of her \nambulatory hypoxia was not entirely clear. Her CXR showed small \nL>R pleural effusions. OSH records showed that the pt had a CXR \nearlier in the month which also showed a small L pleural \neffusion. It was not felt that this pleural effusion was enough \nto tap. Nor was it felt that the pleural effusions were likely \nsignificant enough to account for the pt's ambulatory hypoxia. \nOn admission, there was a question of CHF, but the pt had a \nrecent TTE ___ at the OSH which showed an EF of 55-65% \nwithout evidence of diastolic dysfunction. The pt did not have \nsigns of volume overload on exam so she was not diuresed. Other \nthoughts surrounding the etiology of her ambulatory hypoxia \nincluded obstructive or restrictive lung disease, intermittent \narrhythmias resulting in poor forward flow and possible \npulmonary congestion with exertion. It was difficult to \ndetermine the etiology in the setting of a normal lung exam, \nlack of subjective symptoms (including dyspnea), and stable \nsaturations in 98-100% range on RA at rest. On the day of \ndischarge, the pt did well with ___ and desatted now lower than \n91% with normal activity. When exerted beyond her normal \nactivities, she desatted to 89% but quickly resolved to high ___ \nwith rest and pursed lip breathing. While the etiology of her \nambulatory hypoxia was not clear, after doing well with ___, she \nwas determined to be stable for discharge.\n.\n# Hypokalemia: Pt presented with K of 2.3, which resolved with \naggressive repletion in the ED. It was thought that this was \nlikely related to home fludrocortisone, which pt was prescribed \nfor orthostatic hypotension on d/c ___ from OSH. Pt was not \nentirely sure whether she was still taking this at home on \nadmission, but based on recent discharge, it seemed this was the \nmost likely cause. \n.\n# Tachycardia, resolved: Pt with some mild tachycardia on \npresentation to the ED and early in the admission to low 100s. \nThis may have been from hypovolemia in combination with 2days \noff metoprolol (because pt ran out). Tachycardia resolved early \non HD1.\n.\n# Leukocytosis: WBC 12.5 on admission up to 13.6, and down to 11 \non day of discharge. Unclear etiology. Pt without infectious \nsymptoms. No urinary symptoms. No cough or infiltrate on CXR. \n___ cx NGTD. Pt's UA slightly positive in ED with 12WBC, so she \nwas given nitrofurantoin x1 and cipro x1 on arrival to the \nfloor. In the absence of symptoms, her ABX were discontinued and \nher ucx was subsequently negative. \n.\n>> Chronic issues:\n# Gout: She is stable on her current regimen, so home \nallopurinol was continued.\n\n# Hypertension: Per OSH records and ___ report, looks like pt's \nbaseline SBP runs high, up to 160-180s. Her SBP remained \nelevated during her admission as well, up to 180 systolic, but \ngenerally her SBP was approx 140s during her admission. She was \ncontinued on her home regimen of amlodipine, metoprolol and \nirbesartan.\n\n# H/o syncope: recent admission at ___ from ___ after a \nsyncopal episode. Per OSH records, appears that pt with hx of a \nfew episodes of syncope over span of years. Episodes sound like \npt sitting and suddenly passes out without preceding warning \nsigns. This sounded most like cardiac arrhythmia. Pt had neuro \nand cards consult at ___ during recent admission. \nPt was to have OP holter monitor which she has not yet done. \nAfter discussion with the family and interest in transferring \nall care to ___, she was instructed to establish with new PCP, \n___, here at ___ per her wishes and discuss holter \nmonitoring with Dr. ___.\n\n# Orthostatic hypotension: recent admission to OSH for syncope. \nThought to possibly also have component of orthostatic \nhypotension (OSH positive orthostatics from SBP of 150-180 to \n120-130 when standing). During admission, pt with positive \northostatics with SBP from 150-->120 though asymptomatic. On day \nof discharge, orthostatic vitals were negative when working with \n___. Pt was instructed to discontinue the fludrocortisone \nprescribed after her recent admission to the OSH.\n\n# Hypothyroidism: Stable on current regimen. Continued \nlevothyroxine.\n.\n>> Transitional issues:\n- Pt transferring all care to ___. Plans to establish Dr. ___ \nas new PCP. Appt set up for late ___, so pt and her family \ninstructed to call and move up appt in hopes to be seen in next \n___. Encouraged pt and her family to obtain all past records \nto provide to Dr. ___. \n- Pt will likely benefit from holter monitoring in the OP \nsetting to further workup her h/o syncope."}}
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{'final_diagnoses': ['Hypokalemia', 'Hypertension'], 'procedures': ['None'], 'visit_summary': "with h/o HTN, HLD who was sent to the ED by her visiting \nnurse for tachycardia and found to have ambulatory hypoxia. \n.\n>> Active issues:\n# Ambulatory Hypoxia: Patient was noted to be hypoxic on \nambulation when in the ED to 89%. Pt was without hypoxia at rest \nsatting 98-100% RA and generally without complaints of dyspnea. \nHer lungs were clear to auscultation. The etiology of her \nambulatory hypoxia was not entirely clear. Her CXR showed small \nL>R pleural effusions. OSH records showed that the pt had a CXR \nearlier in the month which also showed a small L pleural \neffusion. It was not felt that this pleural effusion was enough \nto tap. Nor was it felt that the pleural effusions were likely \nsignificant enough to account for the pt's ambulatory hypoxia. \nOn admission, there was a question of CHF, but the pt had a \nrecent TTE ___ at the OSH which showed an EF of 55-65% \nwithout evidence of diastolic dysfunction. The pt did not have \nsigns of volume overload on exam so she was not diuresed. Other \nthoughts surrounding the etiology of her ambulatory hypoxia \nincluded obstructive or restrictive lung disease, intermittent \narrhythmias resulting in poor forward flow and possible \npulmonary congestion with exertion. It was difficult to \ndetermine the etiology in the setting of a normal lung exam, \nlack of subjective symptoms (including dyspnea), and stable \nsaturations in 98-100% range on RA at rest. On the day of \ndischarge, the pt did well with ___ and desatted now lower than \n91% with normal activity. When exerted beyond her normal \nactivities, she desatted to 89% but quickly resolved to high ___ \nwith rest and pursed lip breathing. While the etiology of her \nambulatory hypoxia was not clear, after doing well with ___, she \nwas determined to be stable for discharge.\n.\n# Hypokalemia: Pt presented with K of 2.3, which resolved with \naggressive repletion in the ED. It was thought that this was \nlikely related to home fludrocortisone, which pt was prescribed \nfor orthostatic hypotension on d/c ___ from OSH. Pt was not \nentirely sure whether she was still taking this at home on \nadmission, but based on recent discharge, it seemed this was the \nmost likely cause. \n.\n# Tachycardia, resolved: Pt with some mild tachycardia on \npresentation to the ED and early in the admission to low 100s. \nThis may have been from hypovolemia in combination with 2days \noff metoprolol (because pt ran out). Tachycardia resolved early \non HD1.\n.\n# Leukocytosis: WBC 12.5 on admission up to 13.6, and down to 11 \non day of discharge. Unclear etiology. Pt without infectious \nsymptoms. No urinary symptoms. No cough or infiltrate on CXR. \n___ cx NGTD. Pt's UA slightly positive in ED with 12WBC, so she \nwas given nitrofurantoin x1 and cipro x1 on arrival to the \nfloor. In the absence of symptoms, her ABX were discontinued and \nher ucx was subsequently negative. \n.\n>> Chronic issues:\n# Gout: She is stable on her current regimen, so home \nallopurinol was continued.\n\n# Hypertension: Per OSH records and ___ report, looks like pt's \nbaseline SBP runs high, up to 160-180s. Her SBP remained \nelevated during her admission as well, up to 180 systolic, but \ngenerally her SBP was approx 140s during her admission. She was \ncontinued on her home regimen of amlodipine, metoprolol and \nirbesartan.\n\n# H/o syncope: recent admission at ___ from ___ after a \nsyncopal episode. Per OSH records, appears that pt with hx of a \nfew episodes of syncope over span of years. Episodes sound like \npt sitting and suddenly passes out without preceding warning \nsigns. This sounded most like cardiac arrhythmia. Pt had neuro \nand cards consult at ___ during recent admission. \nPt was to have OP holter monitor which she has not yet done. \nAfter discussion with the family and interest in transferring \nall care to ___, she was instructed to establish with new PCP, \n___, here at ___ per her wishes and discuss holter \nmonitoring with Dr. ___.\n\n# Orthostatic hypotension: recent admission to OSH for syncope. \nThought to possibly also have component of orthostatic \nhypotension (OSH positive orthostatics from SBP of 150-180 to \n120-130 when standing). During admission, pt with positive \northostatics with SBP from 150-->120 though asymptomatic. On day \nof discharge, orthostatic vitals were negative when working with \n___. Pt was instructed to discontinue the fludrocortisone \nprescribed after her recent admission to the OSH.\n\n# Hypothyroidism: Stable on current regimen. Continued \nlevothyroxine.\n.\n>> Transitional issues:\n- Pt transferring all care to ___. Plans to establish Dr. ___ \nas new PCP. Appt set up for late ___, so pt and her family \ninstructed to call and move up appt in hopes to be seen in next \n___. Encouraged pt and her family to obtain all past records \nto provide to Dr. ___. \n- Pt will likely benefit from holter monitoring in the OP \nsetting to further workup her h/o syncope.", 'medications_prescribed': ['Allopurinol ___ mg PO DAILY', 'Amlodipine 10 mg PO DAILY', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 40 mg PO DAILY', 'irbesartan *NF* 300 mg Oral daily', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Metoprolol Tartrate 50 mg PO BID', 'RX *metoprolol tartrate 50 mg 1 tablet(s) by mouth twice daily \nDisp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'F', 'symptoms': 'Cardiac arrest', 'medical_history': ['1. CVD Risk Factors \n- HTN \n- DM \n- Dyslipidemia', '2. Cardiac History \n- AFib on apixaban\n(No prior MI or cardiac cath)', '3. Other PMH \n- Sigmoid adenocarcinoma s/p colectomy (___)\n- BPH'], 'family_history': 'Father died of MI at age ___. ', 'present_illness': '___ yo M w/ AFib on apixaban, HTN, NIDDM, hyperlipidemia who\npresented with sudden syncope and chest pressure. He was sitting\neating breakfast when he started to feel lightheaded. He also\nnoted some chest discomfort that radiated to the back. He went \nto\nthe bathroom and the next thing he remembers is waking up on the\nfloor of the bathroom. He did not bite his tongue or have\nincontinence. His wife witnessed the event and called an\nambulance. He was taken to ___. \n\nWhile in the ED, he developed V tach, torsades, and V fib \narrest.\nHe received chest compressions, defibrillation, epinephrine,\namiadarone, and Mg. He was hypotensive with SBPs in ___ and was\nstarted on norepinephrine. He required ___ O2 by NC. He was\ntaken to the cath lab and underwent coronary angiogram via R\nradial access which showed severe 3 vessel CAD and DES were\nplaced in the RCA x3 and LCX x2. He was subsequently weaned off\nof norepinephrine and transferred to the CCU.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sertraline', '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': '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': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, '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': '42.5', 'valuenum': 42.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVS: Reviewed in metavision \nGENERAL: Well developed, well nourished in NAD. Oriented x3.\nMood, affect appropriate. \nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\nNECK: Supple. No JVD. \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or\ngallops. \nLUNGS: No chest wall deformities or tenderness. Respiration is\nunlabored with no accessory muscle use. No adventitious breath\nsounds. \nABDOMEN: Soft, non-tender, non-distended. Midline surgical scar\nfrom prior colectomy. No palpable hepatomegaly or splenomegaly. \n\nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or\nperipheral edema. \nSKIN: No significant lesions or rashes. \nPULSES: Distal pulses 2+ and symmetric. \n\nDISCHARGE PHYSICAL EXAMINATION: \nGENERAL: Well developed, well nourished in NAD. Oriented x3.\nMood, affect appropriate. \nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\nNECK: Supple. No JVD. \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or\ngallops. \nLUNGS: No chest wall deformities or tenderness. Respiration is\nunlabored with no accessory muscle use. No adventitious breath\nsounds. \nABDOMEN: Soft, non-tender, non-distended. Midline surgical scar\nfrom prior colectomy. No palpable hepatomegaly or splenomegaly. \n\nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, 2+ \nedema\nto mid-shin.\nSKIN: No significant lesions or rashes. \nPULSES: Distal pulses 2+ and symmetric. ', 'diagnoses': [{'icd_code': 'R55', 'desc': 'Syncope and collapse'}, {'icd_code': 'I4510', 'desc': 'Unspecified right bundle-branch block'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': 'ADMISSION LABS:\n___ 03:20PM BLOOD WBC-23.6* RBC-3.43* Hgb-9.9* Hct-30.5* \nMCV-89 MCH-28.9 MCHC-32.5 RDW-15.6* RDWSD-50.1* Plt ___\n___ 03:20PM BLOOD ___ PTT-29.0 ___\n___ 03:20PM BLOOD Glucose-205* UreaN-17 Creat-0.8 Na-136 \nK-3.4* Cl-103 HCO3-13* AnGap-20*\n___ 05:00AM BLOOD ALT-57* AST-87* LD(LDH)-245 AlkPhos-60 \nTotBili-0.3\n___ 03:20PM BLOOD Calcium-7.0* Phos-3.4 Mg-2.1\n___ 03:20PM BLOOD cTropnT-<0.01\n___ 08:08PM BLOOD CK-MB-53* cTropnT-1.86*\n___ 05:00AM BLOOD CK-MB-65* cTropnT-2.30*\n___ 02:00PM BLOOD CK-MB-36* cTropnT-0.80*\n___ 03:23PM BLOOD Lactate-5.0*\n___ 09:30PM BLOOD Lactate-3.0*\n___ 05:30AM BLOOD Lactate-1.0\n\n=======================\n\nIMAGING:\n\nCHEST (PORTABLE AP) ___\n \nINDICATION: ___ with CP s/p cardiac arrest// w/ CP s/p Cardiac \nArrest \n \nCOMPARISON: CT of the torso from ___ \n \nFINDINGS: \n \nAP portable upright view of the chest. Overlying EKG leads and \nexternal \npacing wires are noted. There is no focal consolidation, large \neffusion or pneumothorax. There is pulmonary vascular \ncongestion without overt edema. Cardiomediastinal silhouette \nappears normal. Imaged bony structures are intact. \n \nIMPRESSION: \n \nPulmonary vascular congestion, no frank edema. \n\n----------------\n\nLeft Heart Catheterization ___\n\nCoronary Anatomy\n\nDominance: Right\n* Left Main Coronary Artery\nThe LMCA is short and free of significant disease.\n* Left Anterior Descending\nThe LAD has 70% proximal stenosis.\nThe ___ Diagonal is\n* Circumflex\nThere is a 90% stenosis in the Proximal Circumflex. The lesion \nhas a TIMI flow of 3 and has mild calcification noted. This \nlesion is further described as diffusely diseased. An \nintervention was performed\non the Proximal Circumflex with a final stenosis of 0%. There \nwere no lesion complications. There is 90% stenosis at orign of \nsmall OM upper pole, 80% at bifurcation just after uppe role and \nhazy 90% diffuse\nstenosis in larger OM lower pole.\n* Right Coronary Artery\nThere is a 90% stenosis in the Proximal RCA. The lesion has a \nTIMI flow of 2 and has moderate calcification noted. This lesion \nis further described as diffusely diseased.There are left to \nrigh collaterals. An intervention was performed on the Proximal \nRCA with a final stenosis of 0%. There were no lesion \ncomplications.\n\n------------------\n\nTTE ___:\n\nCONCLUSION:\n\nThe left atrial volume index is normal. There is no evidence for \nan atrial septal defect by 2D/color Doppler. The estimated right \natrial pressure is ___ mmHg. There is mild symmetric left \nventricular hypertrophy with a normal cavity size. There is mild \nregional left ventricular systolic dysfunction with hypokinesis \nof the basal and mid inferior and inferolateral walls (see \nschematic) and preserved/normal contractility of the remaining \nsegments. No thrombus or mass is seen in the left ventricle. \nQuantitative biplane left ventricular ejection fraction is 53 %. \nThere is no resting left ventricular outflow tract gradient. No \nventricular septal defect is seen. Tissue Doppler suggests an \nincreased left ventricular filling pressure (PCWP greater than \n18mmHg). There is Grade II diastolic dysfunction. Normal right \nventricular cavity size with normal free wall motion. The aortic \nsinus diameter is normal for gender with normal ascending aorta \ndiameter for gender. The aortic arch diameter is normal. The \naortic valve leaflets (3) are mildly thickened. There is no \naortic valve stenosis. There is no aortic regurgitation. The \nmitral valve leaflets are mildly thickened with no mitral valve \nprolapse. There is mild [1+] mitral regurgitation. The tricuspid \nvalve leaflets appear structurally normal. There is physiologic \ntricuspid regurgitation. The pulmonary artery systolic pressure \ncould not be estimated. There is a trivial pericardial effusion.\n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \nnormal cavity size and mild regional systolic dysfunction c/w \nCAD in an RCA distribution. Hyperechoic region in the inferior \nand inferolateral walls c/w scarring/fibrosis. Increased PCWP. \nGrade II diastolic dysfunction. Mild mitral regurgitation.\n\n===================\n\nDISCHARGE LABS:\n___ 06:41AM BLOOD WBC-7.6 RBC-3.41* Hgb-10.0* Hct-29.3* \nMCV-86 MCH-29.3 MCHC-34.1 RDW-15.2 RDWSD-47.1* Plt ___\n___ 06:41AM BLOOD ___ PTT-30.9 ___\n___ 06:41AM BLOOD Glucose-102* UreaN-10 Creat-0.7 Na-138 \nK-3.3* Cl-100 HCO3-26 AnGap-12\n___ 06:41AM BLOOD Calcium-8.5 Phos-3.3 Mg-1.___\nw/ AFib on apixaban, HTN, NIDDM, hyperlipidemia who \npresented with sudden syncope and chest pressure to BI-M found \nto have NSTEMI c/b V tach, torsades, and V fib arrest \ntransferred to ___ s/p LHC on ___ with DES x3 to RCA and \nLCX.\n\n======================\n#CORONARIES: Severe 3VD CAD with LAD 70% ___, LCx 90%, RCA 90% \n___ s/p DES x3 to RCA and LCX ___\n#PUMP: EF 50%, regional HK in RCA distribution\n#RHYTHM: Sinus\n=======================\n\n#NSTEMI\n#Severe CAD s/p ___\nECG showed diffuse ST segment depression c/w global ischemia. \nInitial trop negative, then peaked on ___ @ 5AM w/ MB 65, \nTrop-T 2.30. LHC ___ showed severe 3VD s/p DES x3 to RCA and \nLCx. Treated with hep gtt, aspirin, clopidogrel, atorvastatin 80 \nmg, metoprolol. Plan for staged PCI with follow up in 1 month \nfor treatment of LAD stenosis 70%. ___ worked with patient prior \nto discharge and cleared him to go home. \n\n#Post-cardiac arrest: Pt had VT/Vfib arrest at OSH in setting of \nNSTEMI. ROSC obtained after 2 minutes with complete neuro \nrecovery. \n\n#Paroxysmal atrial fibrillation: In sinus rhythm on admission. \nHome apixaban was held initially while on hep gtt for ACS then \nrestarted prior to discharge.\n\n#Hypertension: Home SBP ~130. Initially home antihypertensives \nwere held while on pressors, then restarted prior to discharge. \nPatient will need close follow-up of his blood pressures as \nprior to discharge, they were still in the SBPs 170s for most of \nthe day. \n\n#BPH: Continued home terazosin. \n\n#NIDDM: ISS while hospitalized. Held home metformin and \nrestarted prior to discharge. \n\n=============================\nTRANSITIONAL ISSUES: \n- Consider increasing hydralazine for better BP control (SBPs on \nday of discharge 170s). Responded well (SBP 140s) to extra dose \nof IV hydralazine 10mg. \n- Aspirin/Plavix/apixaban triple therapy for now: Plavix 75 mg \ndaily x minimum 3 months. ___ continue apixaban and consider \nstopping aspirin after 1 month depending on repeat cath in 1 \nmonth for LAD stenosis. \n- Planning for staged PCI with LAD intervention in 1 month\n- Post-Discharge Follow-up Labs Needed: Chem 10 in ___ weeks to \nmonitor electrolytes, kidney function on new meds\n- Discharge weight: 61.6 kg \n# CODE: Full code'}}
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{'final_diagnoses': ['Acute non-ST elevation myocardial infarction', '# Coronary artery disease', '# Diabetes mellitus', '# Hypertension', '# Atrial fibrillation'], 'procedures': ['Left heart catheterization ___'], 'visit_summary': 'w/ AFib on apixaban, HTN, NIDDM, hyperlipidemia who \npresented with sudden syncope and chest pressure to BI-M found \nto have NSTEMI c/b V tach, torsades, and V fib arrest \ntransferred to ___ s/p LHC on ___ with DES x3 to RCA and \nLCX.\n\n======================\n#CORONARIES: Severe 3VD CAD with LAD 70% ___, LCx 90%, RCA 90% \n___ s/p DES x3 to RCA and LCX ___\n#PUMP: EF 50%, regional HK in RCA distribution\n#RHYTHM: Sinus\n=======================\n\n#NSTEMI\n#Severe CAD s/p ___\nECG showed diffuse ST segment depression c/w global ischemia. \nInitial trop negative, then peaked on ___ @ 5AM w/ MB 65, \nTrop-T 2.30. LHC ___ showed severe 3VD s/p DES x3 to RCA and \nLCx. Treated with hep gtt, aspirin, clopidogrel, atorvastatin 80 \nmg, metoprolol. Plan for staged PCI with follow up in 1 month \nfor treatment of LAD stenosis 70%. ___ worked with patient prior \nto discharge and cleared him to go home. \n\n#Post-cardiac arrest: Pt had VT/Vfib arrest at OSH in setting of \nNSTEMI. ROSC obtained after 2 minutes with complete neuro \nrecovery. \n\n#Paroxysmal atrial fibrillation: In sinus rhythm on admission. \nHome apixaban was held initially while on hep gtt for ACS then \nrestarted prior to discharge.\n\n#Hypertension: Home SBP ~130. Initially home antihypertensives \nwere held while on pressors, then restarted prior to discharge. \nPatient will need close follow-up of his blood pressures as \nprior to discharge, they were still in the SBPs 170s for most of \nthe day. \n\n#BPH: Continued home terazosin. \n\n#NIDDM: ISS while hospitalized. Held home metformin and \nrestarted prior to discharge. \n\n=============================\nTRANSITIONAL ISSUES: \n- Consider increasing hydralazine for better BP control (SBPs on \nday of discharge 170s). Responded well (SBP 140s) to extra dose \nof IV hydralazine 10mg. \n- Aspirin/Plavix/apixaban triple therapy for now: Plavix 75 mg \ndaily x minimum 3 months. ___ continue apixaban and consider \nstopping aspirin after 1 month depending on repeat cath in 1 \nmonth for LAD stenosis. \n- Planning for staged PCI with LAD intervention in 1 month\n- Post-Discharge Follow-up Labs Needed: Chem 10 in ___ weeks to \nmonitor electrolytes, kidney function on new meds\n- Discharge weight: 61.6 kg \n# CODE: Full code', 'medications_prescribed': ['Aspirin 81 mg PO DAILY \nRX *aspirin [Adult Aspirin Regimen] 81 mg 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*0 ', 'Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*2 ', 'Hydrochlorothiazide 25 mg PO DAILY \nRX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0 ', 'Lisinopril 40 mg PO DAILY \nRX *lisinopril 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0 ', 'Atorvastatin 80 mg PO QPM \nRX *atorvastatin 80 mg 1 tablet(s) by mouth at night Disp #*30 \nTablet Refills:*1 ', 'Apixaban 5 mg PO BID atrial fibrillation ', 'HydrALAZINE 25 mg PO Q6H hypertension ', 'MetFORMIN (Glucophage) 1000 mg PO BID diabetes ', 'Metoprolol Succinate XL 200 mg PO DAILY hypertension ', 'Terazosin 4 mg PO BID BPH ']}
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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': 'transfer for cholangitis', 'medical_history': ['T2DM', 'GERD', 'EtOH abuse', 's/p lap cholecystectomy in ___'], 'family_history': 'Son and 2 brothers with history of EtOH abuse.', 'present_illness': "Mr. ___ is a ___ PMHx lap cholecystectomy in ___, hx EtOH \nuse, and DM2, who is transferred from ___ for \nabdominal pain since ___. \n\nAt ___, he arrived febrile to 103. LFTs were elevated \nwith AST 154, ALT 319, alk phos 179, Tbili 8.9, and lactate \nelevated to 4.3. CT abdomen/pelvis w/contrast showed a soft \ntissue mass in the CBD; given the constellation of his lab \nabnormalities and symptoms, his presentation was concerning for \ncholangitis and he was transferred to ___. He was given \ncefoxitin and 500 cc's NS bolus prior to transfer. \n\nIn the ED, initial vitals were 98.6, 101, 115/70, 22, 95% on RA. \n His exam was notable for RUQ and epigastric tenderness and \nabdominal distension. His initial labs showed wnl chemistries, \nWBC 11.5 w/o left shift, Hgb 13.7, and Plt 64. His lactate \nprior to transfer to the floor was 2.4. No additional imaging \nwas obtained. The patient was given 2L NS and started on Zosyn. \n\n\nOn the floor, the patient reports that he feels overall well. \nHe states that his pain has subsided and denies any n/v. He \ndenies any chest pain, abdominal pain, changes in bowel habits, \ndysuria.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', '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': '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 via patient discharge', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'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 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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', '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': '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', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, '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': 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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '___', 'valuenum': 312.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '294', 'valuenum': 294.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-62', 'valuenum': -62.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 301.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.25, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 28.0, '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': 'VEN.', '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 228.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '6', 'valuenum': 6.0, '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': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '40.4', 'valuenum': 40.4, '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': '15', 'valuenum': 15.0, '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': '112', 'valuenum': 112.0, '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': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 81.0, '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': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 175.0, 'valueuom': 'mg/dL', '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': 'VEN.', '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 251.0, 'valueuom': 'mg/dL', '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': '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': 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': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '73', 'valuenum': 73.0, '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': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 294.0, 'valueuom': 'mg/dL', '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, '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': '164', 'valuenum': 164.0, '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': '4.61', 'valuenum': 4.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals Signs: 98.2, 130/71, 88, 18, 97% on RA\nGeneral: Alert, oriented, elderly male lying flat in bed in no \nacute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, poor dentition, \nEOMI, PERRL, neck supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nAbdomen: Soft, obese, mild TTP of epigastrium and RUQ, no \nrebound or guarding, + bowel sounds \nGU: No foley \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro: AOx3, grossly nonfocal \nAccess: PIV x 1\n\nDISCHARGE PHYSICAL EXAM:\nVS: 98.3 151 / 81 73 18 98 RA \nGen: Well-appearing elder male, eating breakfast, NAD\nHEENT: NCAT, EOMI, PERRLA, anicteric sclera, clear OP, MMM, poor \ndentition\nCardiac: RRR, no r/g/m\nChest: CTAB\nAbd: Soft NT ND +BS\nExt: WWP, no edema\nNeuro: AAOx3, face symmetric, moving all four extremities', 'diagnoses': [{'icd_code': 'E1010', 'desc': 'Type 1 diabetes mellitus with ketoacidosis without coma'}, {'icd_code': 'K226', 'desc': 'Gastro-esophageal laceration-hemorrhage syndrome'}, {'icd_code': 'L80', 'desc': 'Vitiligo'}, {'icd_code': 'R109', 'desc': 'Unspecified abdominal pain'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'E869', 'desc': 'Volume depletion, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': "___ 09:30PM BLOOD WBC-11.5* RBC-4.62 Hgb-13.7 Hct-40.8 \nMCV-88 MCH-29.7 MCHC-33.6 RDW-12.8 RDWSD-41.7 Plt Ct-64*\n___ 09:30PM BLOOD Neuts-57 Bands-31* Lymphs-6* Monos-6 \nEos-0 Baso-0 ___ Myelos-0 AbsNeut-10.12* \nAbsLymp-0.69* AbsMono-0.69 AbsEos-0.00* AbsBaso-0.00*\n___ 10:48PM BLOOD ___ PTT-26.4 ___\n___ 09:30PM BLOOD Glucose-244* UreaN-27* Creat-1.1 Na-139 \nK-3.7 Cl-101 HCO3-22 AnGap-20\n___ 09:30PM BLOOD ALT-274* AST-144* AlkPhos-161* \nTotBili-9.2*\n___ 09:30PM BLOOD Lipase-21\n___ 09:50PM BLOOD Lactate-3.1*\n\nIMAGING:\n___ CXR\nImpression: No acute cardiopulmonary process. \n\n___ CT ABDOMEN/PELVIS W/CONTRAST\nIMPRESSION:\n1. Interval development of intrahepatic and extrahepatic biliary \nductal dilatation with distal common bile duct/ampullary soft \ntissue density. This may suggest the patient's clinical \nsymptomatology of pain, fever and raised white count in a \npatient status post cholecystectomy. ERCP and/or MRCP \nrecommended.\n2. A 7.5 mm nonobstructive radiopaque calculi in the mid right \nkidney.\n3. A fat-containing umbilical hernia.\n\nERCP:\nImpression: \x95Limited exam of the esophagus was normal\n\x95Limited exam of the stomach was normal\n\x95Limited exam of the duodenum was normal\n\x95The scout film revealed surgical clips in the RUQ. \n\x95The major papilla was on the lateral rim of a large \nperiampullary diverticulum. \n\x95The CBD was successfully cannulated with the CleverCut 3V \nsphincterotome preloaded with a 0.025in guidewire. \n\x95The guidewire was advanced into the intrahepatic biliary tree. \n\x95Contrast injection revealed a dilated CBD to approximately 12mm \nin diamtere and multiple filling defects consistent with stones \nin the mid/distal CBD. \n\x95The intrahepatic biliary tree was unremarkable.\n\x95A small sphincterotmy was successfully performed at the 12 \no'clock position followed by balloon sphincteroplasty with a \n12mm CRE balloon dilator. \n\x95No post sphicnterotome bleeding was noted. \n\x95The CBD was swept several times with successful removal of 6 \nstones and moderate amounts of sludge material. \n\x95Occlusion cholangiogram showed no further filling defects. \n\x95Due to multiple stones a ___ X 5 cm Advanix double pigtail \nbiliary stent was successfully placed across the ampulla. \n\x95There was excellent spontaneous drainage of bile and contrast \nmaterial at the end of the procedure.\n\x95The PD was not injected or cannulated.\n\nDISCHARGE LABS:\n___ 07:05AM BLOOD WBC-8.1 RBC-4.33* Hgb-12.7* Hct-38.4* \nMCV-89 MCH-29.3 MCHC-33.1 RDW-12.4 RDWSD-40.5 Plt Ct-60*\n___ 07:05AM BLOOD ___ PTT-27.7 ___\n___ 07:05AM BLOOD Glucose-125* UreaN-19 Creat-0.7 Na-139 \nK-3.6 Cl-103 HCO3-26 AnGap-14\n___ 07:05AM BLOOD ALT-207* AST-99* AlkPhos-127 TotBili-3.4* \nDirBili-2.8* IndBili-0.6\n___ 07:05AM BLOOD Calcium-8.2* Phos-2.1* Mg-2.___\nhx lap cholecystectomy in ___, hx EtOH use, DM2, \ntransferred from ___ for abdominal pain, \nfound to have cholangitis. \n\n# Sepsis\n# Cholangitis:\nOSH imaging showed intrahepatic and extrahepatic biliary ductal \ndiltation with soft tissue density in the CBD concerning for \npossible cholangitis and biliary obstruction. Patient had \nfindings of sepsis on admission. Started on Zosyn, transitioned \nto CTX/Flagyl while awaiting ERCP that showed stones in CBD \nwhich were swept, with sphincterotomy and stent placement done. \nHe was able to tolerate a regular diet before discharge, will \nhave to return per ERCP for stent pull, and complete 5 days of \nantibiotics after discharge. \n\n# Hypertension:\nHome antihypertensives were held in the setting of sepsis. ___ \nrestart after discharge. \n\n# T2DM:\nPatient was on insulin sliding scale here while home \nglimepiride.\n\n# GERD:\nContinued home PPI.\n\n# Hyperlipidemia:\nHome statin and fenofibrate were held pending post-discharge LFT \ncheck.\n\n# ADHD:\nHome Ritalin was continued."}}
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{'final_diagnoses': ['Cholangitis'], 'procedures': ['ERCP'], 'visit_summary': 'hx lap cholecystectomy in ___, hx EtOH use, DM2, \ntransferred from ___ for abdominal pain, \nfound to have cholangitis. \n\n# Sepsis\n# Cholangitis:\nOSH imaging showed intrahepatic and extrahepatic biliary ductal \ndiltation with soft tissue density in the CBD concerning for \npossible cholangitis and biliary obstruction. Patient had \nfindings of sepsis on admission. Started on Zosyn, transitioned \nto CTX/Flagyl while awaiting ERCP that showed stones in CBD \nwhich were swept, with sphincterotomy and stent placement done. \nHe was able to tolerate a regular diet before discharge, will \nhave to return per ERCP for stent pull, and complete 5 days of \nantibiotics after discharge. \n\n# Hypertension:\nHome antihypertensives were held in the setting of sepsis. ___ \nrestart after discharge. \n\n# T2DM:\nPatient was on insulin sliding scale here while home \nglimepiride.\n\n# GERD:\nContinued home PPI.\n\n# Hyperlipidemia:\nHome statin and fenofibrate were held pending post-discharge LFT \ncheck.\n\n# ADHD:\nHome Ritalin was continued.', 'medications_prescribed': ['Atenolol 25 mg PO DAILY', 'Rosuvastatin Calcium 10 mg PO QPM', 'FoLIC Acid 1 mg PO DAILY', 'glimepiride 1 mg oral QHS', 'Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'MethylPHENIDATE (Ritalin) 20 mg PO TID', 'Fenofibrate 145 mg PO DAILY', 'glimepiride 2 mg oral DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 18, 'gender': 'M', 'symptoms': 'worsening confusion, delirium', 'medical_history': ['HTN', 'HLD', 'Hypothyroidism', 'RT cerebellar hemorrhage in ___', 'RT thalamic hemorrhagic stroke (___) c/b hydrocephalus\ns/p EVD (now removed ___'], 'family_history': 'Adopted, no known family history', 'present_illness': "Mr. ___ is a ___ gentleman with an \nextensive\nneurologic history including R cerebellar hemorrhagic stroke in\n___ with good recovery followed by a new R thalamic \nhemorrhage\nin ___ followed here on the stroke service. He presents\ntoday with concerns from his family and physician who was caring\nfor him at the ___ due to 3 weeks of decline in regards to his\nmental status, language abilities, swallowing abilities. \n\nBriefly to review his medical history, the patient suffered a\nhypertensive R cerebellar hemorrhage in ___. After this\nstroke his family states that he returned to 95% of his baseline\nfuncitoning and even went back to teaching. At the end of \n___\nof this year, the patient was brought in with slurred speech and\ndecreased level of consciousness and was found to havea large R\nthalamic hemorrhage with IVE thought to be due to HTN. An evd \nwas\nplaced. He suffered from severe dysarthria and weakness in his L\narm and leg. After initial management the patient improved\nsignificantly, he had improved strength and was discharged to\n___. Prior to rehab thepatient had a PEG tube placed\ndue to dysphagia. \n\nDuring the first two weeks of rehab, the patient did remarkably\nwell , he was able to start ambulating with a walker. He\neventually was transitioned to a PO diet as well as his \ndysphagia\nsignificantly improved. On ___, the patient started to develop\nfever to 103.7 and a new leukocytosis. Patient was found to have\nUTI and was started on cipro. He continued to have more fevers \nas\nwell as tachycardia and cough. Patient had CXR which showed RUL\npneumonia. He was transferred to ___ for further evaluation \nand\nadmitted to the medical service. The pneumonia was thought to be\ndue to aspiration. Patient was treated with antibiotics and\nrecovered well. During this same hospitalization, the patient \nwas\nnoted to be altered as he was oriented to self but not location\nor year no other description of mental status. \n\nAccording to his family however, he recovered well from this\nrecent admission and went back to ___. At ___ he\ncontinued to improve and was discharged to an LTAC in ___. While at this LTAC, within the first few days, his family noted\nan acute decline. He had ___ falls in the first two days mainly\nbecause he was impulsive and got up out of bed alone trying to\nuse the bathroom. He also became much more dysarthic and\ndeveloped tremors in his UE and LEs. He began to hallucinate\nwhich has been ongoing. The patient was taken to ___\nwhere he was admitted and seen by neurology. Repeat ct scan done\nthere was normal. EEG was done and showed a moderate\nencephelopathy without epileptiform discharges. For unclear\nreasons the patient was started on keppra 500mg BID. The notes\nsay due to concern for GTC, however on speaking with the\npatient's family they state that there was never any generalized\ntonic clonic seizure episode, but more concern just for falls \nand\nchange in mental status. \n\nThe patient was discharged from ___ on ___ but still has\nnot returned to baseline. His mental status waxes and wanes at\ntimes he is lucid, othertimes he is not oriented and is\nhallucinating. His strength remains good but he is becoming more\ndysarthric as time goes on. Given these changes, his family\nbrought him in for further evaluation.", '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': 'Montelukast Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': '=============== \nADMISSION EXAM: \n=============== \n\nGeneral: awake, whole body tremors, no acute distress\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx\nNeck: supple, no nuchal rigidity\nPulmonary: breathing comfortably on room air\nCardiac: RRR, nl\nAbdomen: soft, NT/ND\nExtremities: warm, well perfused\nSkin: no rashes or lesions noted\n\nNeurologic:\n\n-Mental Status: Alert, lying with eyes closed, briefly opens\neyes, in no acute distress. Extremely dysarthric and difficult \nto\nunderstand patient. Cannot give a detailed history. He is \nhowever\noriented to ___, and is oriented to ___ and ___. He is able\nto follow midline and appendicular commands. He is able to\nrepeat, name "hand, palm, knuckles". He starts talking about\n___ in the room and pulling at invisible items in the air. \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 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\n-Motor: Normal bulk, paratonia throughout. No pronator drift\nbilaterally.\nPostural tremor noted, suppressesible \n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 4+ ___ ___ 5 5 5 5 5 5 5\nR 5 ___ ___ 5 5 5 5 5 5 5\n\n-Sensory: No deficits to light touch\n\n-DTRs:\n Bi Tri ___ Pat Ach\nL 3 3 3 3 2\nR 3 3 3 3 2\nno glabellar , +grasp bilaterally \n\n-Coordination: No dysmetria to FNF \n\n-Gait: deferred \n\n=============== \nDISCHARGE EXAM: \n=============== \nGeneral: lying in bed, NAD\nCV: warm and well-perfused\nResp: breathing comfortably in room air\n\nMental status: Awake in bed, watching TV. Oriented to hospital.\nStates it is ___. Oriented to ___. Naming intact. Follows\nsimple commands. Asks for "fried clams" for breakfast. Overall, \nmuch more interactive, brighter affect.', 'diagnoses': [{'icd_code': '5128', 'desc': 'Other spontaneous pneumothorax'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': 'CLOSTRIDIUM DIFFICILE. \n Positive for toxigenic C difficile by the Cepheid \nnucleic\n amplification assay. \n\n======== \nIMAGING: \n======== \n___, MRI with and without contrast:\n-No new infarct. \n-Late subacute hematoma right thalamus, no worrisome features. \n-Sequela of distant, chronic right cerebellar hemorrhage.. \nPunctate focus of chronic microhemorrhage left thalamus. \n-Findings suggest chronic hypertension and hypertensive \narteriopathy. \n\n___, CT head:\nNo acute intracranial abnormality.\n\n=================== \nAdmission lab work: \n=================== \n\n___ 04:40PM WBC-4.8 RBC-3.78* Hgb-12.2* Hct-36.9* MCV-98 \nPlt ___\n___ 04:40PM Glucose-86 UreaN-29* Creat-1.0 Na-146 K-4.2 \nCl-106 HCO3-28 AnGap-12\n___ 04:40PM ALT-30 AST-22 AlkPhos-122 TotBili-1.4\n___ 04:40PM Albumin-4.0 Calcium-9.0 Phos-3.4 Mg-2.4\n___ 04:45AM VitB12-973* Folate->20\n___ 04:45AM TSH-5.4*\n___ 04:45AM CRP-2.4\n\n=================== \nDischarge lab work: \n=================== \n\n___ 05:15AM BLOOD WBC-7.8 RBC-3.79* Hgb-12.1* Hct-37.2* \nMCV-98 MCH-31.9 MCHC-32.5 RDW-14.6 RDWSD-52.8* Plt ___\n___ 05:15AM BLOOD Glucose-91 UreaN-25* Creat-0.7 Na-147 \nK-3.9 Cl-111* HCO3-26 AnGap-10\n___ 05:15AM BLOOD Calcium-8.5 Phos-3.0 Mg-2.\nyear old man with history of cerebellar hemorrhage and recent \nR thalamic hemorrhage, who presented from his LTAC with recent \nstepwise decline and worsening delirium without any clear source \nor trigger.\n\nHis initial ___ included a CT of the head and MRI brain, \nboth of which showed evidence of his prior intracranial bleeds, \nwithout evidence of new stroke or bleed. He also had an \ninfectious/metabolic ___, which did not reveal any new \ninfection or electrolyte derangements.\n\nHis hospital course was complicated by a new fever on ___. \nA repeat infectious ___ was sent, with negative UA, CXR. \nUrine culture was negative, and blood cultures was no growth to \ndate at discharge. He was noted to have diarrhea and C. diff \ntesting was sent which was positive, and he was started on oral \nvancomycin with planned prolonged course and taper (see taper \nbelow, indicated for recurrent disease). After initiation of C. \ndiff treatment, his confusion and dysarthria began to improve, \nso initial presentation with worsening delirium was attributed \nto likely early C. diff infection.\n\nHis Keppra was initially continued for myoclonus noted on exam. \nThis improved with C. diff treatment, so his Keppra was \ndiscontinued, given low concern for seizure risk. \n\nThe speech and swallow team was consulted and recommended video \nswallow study as an out-patient. He was continued on his tube \nfeeds via PEG.\n\nHe was evaluated by in-patient ___, who recommended discharge to \na rehab facility.\n\nVancomycin pulsed-tapered regimen: \n-125 mg orally four times daily for 14 days (___)\n-125 mg orally twice daily for 7 days (___)\n-125 mg orally once daily for 7 days (___)\n-125 mg orally every 2 days for 8 weeks (___) unless \ninstructed by an MD to follow a shorter course'}}
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{'final_diagnoses': ['C. ___ infection'], 'procedures': ['None'], 'visit_summary': 'year old man with history of cerebellar hemorrhage and recent \nR thalamic hemorrhage, who presented from his LTAC with recent \nstepwise decline and worsening delirium without any clear source \nor trigger.\n\nHis initial ___ included a CT of the head and MRI brain, \nboth of which showed evidence of his prior intracranial bleeds, \nwithout evidence of new stroke or bleed. He also had an \ninfectious/metabolic ___, which did not reveal any new \ninfection or electrolyte derangements.\n\nHis hospital course was complicated by a new fever on ___. \nA repeat infectious ___ was sent, with negative UA, CXR. \nUrine culture was negative, and blood cultures was no growth to \ndate at discharge. He was noted to have diarrhea and C. diff \ntesting was sent which was positive, and he was started on oral \nvancomycin with planned prolonged course and taper (see taper \nbelow, indicated for recurrent disease). After initiation of C. \ndiff treatment, his confusion and dysarthria began to improve, \nso initial presentation with worsening delirium was attributed \nto likely early C. diff infection.\n\nHis Keppra was initially continued for myoclonus noted on exam. \nThis improved with C. diff treatment, so his Keppra was \ndiscontinued, given low concern for seizure risk. \n\nThe speech and swallow team was consulted and recommended video \nswallow study as an out-patient. He was continued on his tube \nfeeds via PEG.\n\nHe was evaluated by in-patient ___, who recommended discharge to \na rehab facility.\n\nVancomycin pulsed-tapered regimen: \n-125 mg orally four times daily for 14 days (___)\n-125 mg orally twice daily for 7 days (___)\n-125 mg orally once daily for 7 days (___)\n-125 mg orally every 2 days for 8 weeks (___) unless \ninstructed by an MD to follow a shorter course', 'medications_prescribed': ['Vancomycin Oral Liquid ___ mg PO QID Duration: 14 Days', 'amLODIPine 5 mg PO DAILY', 'Atenolol 50 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Levothyroxine Sodium 50 mcg PO DAILY', 'Losartan Potassium 100 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'M', 'symptoms': 'pacemaker battery change', 'medical_history': ['Diabetes', 's/p pacemaker', 'Hypertension', 'Hyperlipidemia'], 'family_history': 'Non-contributory', 'present_illness': 'History was obtained with the aid of a ___ interpreter.\n\nMr. ___ is a ___ year old male hx of pacer ___ yrs prior \nunclear indication, hypertension, and hyperlipidemia who \npresented to the ED as, per report, his PCP told him he needed a \npacemaker replacement as the battery is low. Per report, he had \nintermittent dyspnea though the patient denied dyspnea on \ninterview once he had reached the floor. He did report mild \nlower extremity swelling over two days, but denied pain.\n\nED COURSE: VS 98.3, 66, 110/70, 20, 95%RA. Non elevated JVP,RRR, \nbibasilar crackles reported, no ___ edema. CXR with Low \ninspiratory lung volumes and a patchy opacity at the left lung \nunclear whether atelectasis. WBC 12.4, close to last check in \n___. Creatinine 1.4, 1.2 in ___. Discussed with EP in \nED, reported require pacer battery change. Prodigy ___ 7862, AV \npaced. No beds available on CMED, admit to medicine with EP to \nfollow.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '1.1', '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': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.34', 'valuenum': 1.34, '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': '4.2', 'valuenum': 4.2, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.0', 'valuenum': 67.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, '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': '12.3', 'valuenum': 12.3, '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': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.29', 'valuenum': 0.29, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.59', 'valuenum': 0.59, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '38.9', 'valuenum': 38.9, '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': 'HOLD.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '45', 'valuenum': 45.0, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS: 97.1, 150/91, 65, 20, 95% RA \nGen: NAD \nHEENT:NCAT, PERRL, EOMI \nNeck: no masses, non elevated JVP \nCV: paced, RRR no MRG, nl S1, S2 \nResp: crackles right base, no wheeze. No fremitus \nAbd: NABS, soft, NTND, no guarding/rigidity/rebound. Large \nvertical incision scar from ?MVA \nRectal: Guaiac: deferred \nExt: trace pre tibial edema, 2+/4 symmetric pedal pulses', 'diagnoses': [{'icd_code': 'D135', 'desc': 'Benign neoplasm of extrahepatic bile ducts'}, {'icd_code': 'K200', 'desc': 'Eosinophilic esophagitis'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'Z8659', 'desc': 'Personal history of other mental and behavioral disorders'}, {'icd_code': 'Z833', 'desc': 'Family history of diabetes mellitus'}, {'icd_code': 'Z8042', 'desc': 'Family history of malignant neoplasm of prostate'}], 'summary': '___ 06:40PM BLOOD WBC-12.6* RBC-4.83 Hgb-14.1 Hct-43.9 \nMCV-91 MCH-29.3 MCHC-32.2 RDW-13.7 Plt ___\n___ 06:40PM BLOOD Neuts-64.5 ___ Monos-4.5 Eos-2.2 \nBaso-0.5\n___ 06:40PM BLOOD ___ PTT-27.9 ___\n___ 06:40PM BLOOD Glucose-222* UreaN-35* Creat-1.4* Na-144 \nK-4.1 Cl-105 HCO3-27 AnGap-16\n___ 06:40PM BLOOD Calcium-9.5 Phos-3.3 Mg-2.1\n\n___ 07:05AM BLOOD CK(CPK)-140\n___ 07:05AM BLOOD CK-MB-5 cTropnT-<0.01\n\nEKG: paced 65, LAD, no prior for comparison \n \nAdmission CXR: chest portable AP. Low inspiratory lung volumes. \nPatchy opacity at the left lung base could be explained by \natelectasis given low volumes but pneumonia cannot be excluded.\nMr. ___ is an ___ yr old male with a dual chamber \npacemaker, who presented for battery change. He was \nasymptomatic on admission, aside from mild ___ edema. As the \npacemaker was placed at an OSH ___ years ago and he did not \nremember the details of his medical history, the original \nindication for the pacer was unclear. It is suspected that he \nhad sick sinus syndrome.\n\nPulse generator replacement and revision of both atrial and \nventricular leads were performed on ___ without complication \n(please see report for further details). After the procedure, \nhe was kept overnight for observation; chest x-ray in the \nmorning was unchanged from prior films. he was dicharged on a \nfive day course of PPX cephalexin 500 mg QD Q8 hours.\n\nNOTE: had a leukocytosis (WBC 14) on admission, but remained \nafebrile and had no symptoms concerning for an infection. No \nwork-up was pursued given the lack of clinical evidence of \ninfection. He was noted to have an elevated WBC count in \n___, as well, when he presented to ___ for. PCP ___ \nshould include checking ___ for resolution of the leukocytosis.'}}
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{'final_diagnoses': ['Patient admitted for pacemaker battery change.'], 'procedures': ['Revision of pacemaker leads and battery change.'], 'visit_summary': 'Mr. ___ is an ___ yr old male with a dual chamber \npacemaker, who presented for battery change. He was \nasymptomatic on admission, aside from mild ___ edema. As the \npacemaker was placed at an OSH ___ years ago and he did not \nremember the details of his medical history, the original \nindication for the pacer was unclear. It is suspected that he \nhad sick sinus syndrome.\n\nPulse generator replacement and revision of both atrial and \nventricular leads were performed on ___ without complication \n(please see report for further details). After the procedure, \nhe was kept overnight for observation; chest x-ray in the \nmorning was unchanged from prior films. he was dicharged on a \nfive day course of PPX cephalexin 500 mg QD Q8 hours.\n\nNOTE: had a leukocytosis (WBC 14) on admission, but remained \nafebrile and had no symptoms concerning for an infection. No \nwork-up was pursued given the lack of clinical evidence of \ninfection. He was noted to have an elevated WBC count in \n___, as well, when he presented to ___ for. PCP ___ \nshould include checking ___ for resolution of the leukocytosis.', 'medications_prescribed': ['1. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '2. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times a \nday).', '3. Glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day.', '4. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO once a day.', '5. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) for 4 days.\nDisp:*12 Tablet(s)* Refills:*0*', '6. Lisinopril-Hydrochlorothiazide Oral']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 74, 'gender': 'M', 'symptoms': 'Bilateral Leg/Foot Pain', 'medical_history': ['1. CARDIAC RISK FACTORS \n- Diabetes (type 2)\n- Hypertension \n- HLD', '2. CARDIAC HISTORY \n- HFrEF ___, etiology thought to be tachymyopathy)\n- Afib (sp ablation in ___, sp DCCV x 2 within past 2 months, on\napixaban, amiodarone and metoprolol)\n- Moderate to severe MR\n- CABG: None \n- PERCUTANEOUS CORONARY INTERVENTIONS: None \n- PACING/ICD: None ', "3. OTHER PAST MEDICAL HISTORY \n- Hypothyroidism - ___'s \n- Gout\n- CDK stage II/III (Baseline Cr around 1.2-1.3)\n- ___ venous stasis"], 'family_history': 'CAD/PVD in his maternal grandfather; ___ - Type II in his \nmother.', 'present_illness': 'Mr. ___ is a ___ year old man with a medical history notable \nfor\ncrystal proven gout, paroxysmal AF s/p PVI ___ and re-do\nablation ___ complicated by tachycardia-mediated\ncardiomyopathy with MR and TR, severe pulmonary hypertension \nwith\npossible pre-capillary component, hypertension, diabetes,\nobesity, and venous stasis who presents with bilateral leg pain\nin the setting of an active outpatient diuresis.\n\nPatient went to bed feeling completely pain free, just tired \nfrom\na long day at work, awoke around 5AM with excruciating pain,\nwarmth, and swelling in both ankles feet, but the left great toe\nis the most painful area of all joints. His first and only other\ngout flare was ___. He states he has been cramping since\nhis diuretic has been increased, urine output has been good and\nexertional tolerance is improved. There have been no fevers,\nchills, feeling ill. \n\nIn the ED, initial VS were: 98.3 96 145/119 17 100% RA \nExam notable for: in pain, severe venous stasis change, \ndifficult\nlower ext joint exam \nECG: sinus rhythm high ___\nLabs showed: neutrophilic leukocytosis, elevated CRP,\nhyperuricemia, elevated BNP 4737 \nImaging showed: no DVT but limited study \nConsults: None\nPatient received: oxycodone 5mg x 4, K and Mg repletion \nTransfer VS were: 98.9 88 127/68 18 98% RA', 'medications': [{'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Isosorbide Dinitrate', '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', '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': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', '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': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', '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': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'X1: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': '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': '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': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', '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': 'Citalopram', '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': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DINNER', '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': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'imd', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Rosuvastatin Calcium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', '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': 'Levothyroxine Sodium', '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': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.4, . estimated GFR (eGFR) is likely between 49 and 59 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2396.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 852.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.84', 'valuenum': 0.84, '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': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '182', 'valuenum': 182.0, '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': '4.67', 'valuenum': 4.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53.7', 'valuenum': 53.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, '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': '166', 'valuenum': 166.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.29', 'valuenum': 4.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.2', 'valuenum': 53.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, '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': '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': '65', 'valuenum': 65.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '276', 'valuenum': 276.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.3', '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': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '169', 'valuenum': 169.0, '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': '4.61', 'valuenum': 4.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.8', 'valuenum': 51.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68', 'valuenum': 68.0, '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': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', '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': '4.4', 'valuenum': 4.4, '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': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, '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': '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, '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': '51.3', 'valuenum': 51.3, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '23', 'valuenum': 23.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', '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': '31', 'valuenum': 31.0, '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': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', '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': '___', 'valuenum': 10.2, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'Normal Diurnal Pattern: 7-10AM 6.0-18.4 ug/dL / 4-8PM 2.7-10.5 ug/dL.'}, {'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': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.6', 'valuenum': 42.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, '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': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.5', 'valuenum': 51.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS: 98.6 146/87 91 18 96 RA \nGen: laying in bed, no acute distress when still, severe pain\nwhen moving his left big toe \nChest: clear anteriorally \nCV: RRR, S1S2, no murmurs\nMSK: No tophi, most pain in left big toe and this cannot be\nmoved, all other toes okay, feet are "massively swollen" per\npatient and the ankles are stiff as a result, knees okay with\ngood ROM. feet are very warm bilaterally. \nSkin: Severe stasis changes bilaterally \n\nDISCHARGE PHYSICAL EXAM:\nVS: 97.3 PO 103 / 66 L Sitting 55 18 96% on RA \nGEN: obese gentleman in NAD, sitting up on edge of bed\nCARDIO: regular, no murmurs\nPULM: clear anteriorly\nCARDIO: regular, S1S2, no murmurs\nEXT: venous stasis changes and 1+ pedal edema bilaterally\nMSK: no tophi, L great toe swelling mildly decreased but still\nslightly erythematous\nSKIN: severe stasis changes bilaterally as above', 'diagnoses': [{'icd_code': 'I480', 'desc': 'Paroxysmal atrial fibrillation'}, {'icd_code': 'I5022', 'desc': 'Chronic systolic (congestive) heart failure'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'I481', 'desc': 'Persistent atrial fibrillation'}, {'icd_code': 'I447', 'desc': 'Left bundle-branch block, unspecified'}, {'icd_code': 'I428', 'desc': 'Other cardiomyopathies'}, {'icd_code': 'I255', 'desc': 'Ischemic cardiomyopathy'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'Z951', 'desc': 'Presence of aortocoronary bypass graft'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z86718', 'desc': 'Personal history of other venous thrombosis and embolism'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'F39', 'desc': 'Unspecified mood [affective] disorder'}, {'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'E291', 'desc': 'Testicular hypofunction'}, {'icd_code': 'I951', 'desc': 'Orthostatic hypotension'}, {'icd_code': 'E860', 'desc': 'Dehydration'}], 'summary': "___ 07:56PM WBC-10.1* RBC-5.08 HGB-12.7* HCT-43.4 MCV-85 \nMCH-25.0* MCHC-29.3* RDW-16.0* RDWSD-49.5*\n___ 07:56PM NEUTS-79.7* LYMPHS-12.3* MONOS-7.0 EOS-0.2* \nBASOS-0.4 IM ___ AbsNeut-8.06* AbsLymp-1.24 AbsMono-0.71 \nAbsEos-0.02* AbsBaso-0.04\n___ 07:56PM PLT COUNT-174\n___ 07:56PM CRP-49.4*\n___ 07:56PM ALBUMIN-3.8 CALCIUM-8.7 PHOSPHATE-2.3* \nMAGNESIUM-1.7 URIC ACID-10.6*\n___ 07:56PM proBNP-4737*\n___ 07:56PM ALT(SGPT)-15 AST(SGOT)-24 ALK PHOS-104 TOT \nBILI-2.5*\n\nFOOT X-RAY\nIMPRESSION: \nNo definite erosions. Severe skin thickening and soft tissue \nswelling of the dorsal aspect of the right ankle and foot and \nmoderate soft tissue swelling of the left forefoot, primarily \ndorsally. Apparent thickening the bilateral heel fat pads is \nnonspecific and can be seen in acromegaly, obesity, and edema. \n\nDISCHARGE LABS\n___ 04:45AM BLOOD WBC-7.4 RBC-5.07 Hgb-12.8* Hct-44.4 \nMCV-88 MCH-25.2* MCHC-28.8* RDW-16.2* RDWSD-51.5* Plt ___\n___ 04:45AM BLOOD Plt ___\n___ 04:45AM BLOOD Glucose-220* UreaN-50* Creat-1.6* Na-143 \nK-4.2 Cl-97 HCO3-34* AnGap-12\n___ 04:42AM BLOOD ALT-14 AST-18 AlkPhos-107 TotBili-2.6* \nDirBili-1.5* IndBili-1.1\n___ 04:45AM BLOOD Calcium-9.6 Phos-4.7* Mg-2.1\nMr. ___ is a ___ year old man with a medical history notable \nfor crystal proven gout and systolic CHF, also with afib s/p \nablation X 2, who presented with a sudden onset of severe \npolyarticular joint pain consistent with a gout flare, and with \na course notable for improvement in toe pain with systemic \nsteroids and diuresis for CHF exacerbation. \n\n#GOUT: Mr. ___ presented with joint pain worse in his ___ \nbilaterally, along with CRP of 49 and in the setting of crystal \nproven gout in ___. Uric Acid also elevated to 10.6. No signs \nofinfection on exam or by vital signs. Patient was previously \nprescribed colchicine but could not find the prescription at \nhome and, given difficulty ambulating and extreme pain, \npresented for further work-up and management. Of note, he \ndeferred colchicine and possible joint aspiration/injection \nduring admission. He preferred steroids though risks/benefits \nwere discussed. Plain film of the feet only notable for edema. \nHe responded well to systemic steroids and is now ready for \ndischarge. He will complete a course of prednisone at home. \n\n#ACUTE-ON-CHRONIC SYSTOLIC HF: EF of 25%. Patient has \ncardiomyopathy with recent exacerbation requiring increased \ndiuresis. Mechanism of his CHF has been felt to be \ntachycardia-mediated cardiomyopathy with MR and TR and severe \npHTN. He presents with BNP elevated to 4700 from ___ over \npast several weeks. Also with weight of 274lbs on admission. Dry \nweight unclear but weights around 257-260lbs recorded recently. \nDischarge weight is 267-270lbs. Patient is being discharged on \nTorsemide 40mg daily (home diuretic dose) given Cr 1.6 on day of \ndischarge.\n\n___ ON CKD: Patient with ___ to 1.6 on mild CKD. His ___ \ninitially improved with diuresis but then increased again to 1.6 \non the day of discharge. This was likely mildly elevated in the \nsetting of near-euvolemia and ongoing diuresis. He will resume \nhis usual home regimen of Torsemide 40mg daily as above.\n\n#pAF: s/p PVI ___ and re-do ablation ___. Carvedilol, \namiodarone and Eliquis were continued during admission.\n\n#IDDM: Patient was continued on home Lantus and Humalog. He also \nreceived a HISS for correction given steroid course.\n\n#HYPERTENSION: Medications continued as above except for \nHydralazine, which was held due to SBP 100-105 during stay.\n\n#CONGESTIVE HEPATOLOGY WITH UNDERLYING NAFLD: Patient has \nelevated bilirubin on admission. He has history of this in past \nas well. Work-up including RUQ U/S and Liver MRI in ___ showed \ncirrhosis. \n\nTRANSITIONAL ISSUES:\n- Patient is being discharged on Torsemide 40mg daily. Weight at \ndischarge is 270 lbs. Patient's lowest weight this admission was \n267 lbs (day prior to discharge).\n- Cr at discharge was 1.6 (this fluctuated between 1.0 and 1.6 \nduring admission). Please recheck Cr and electrolytes within ___ \ndays after discharge.\n- Patient was discharged on a 5-day steroid taper (30mg X 1 more \nday, 20mg X 2 days, 10mg X 2 days then stop). \n- Patient instructed to monitor his blood sugars closely after \nlunch and dinner until follow-up with PCP. He was given a HISS \n(at his request) to use for correction and was instructed to \ncall his primary care provider if blood sugar is greater than \n400 at home. Please stop this once hyperglycemia ___ steroids) \nresolved.\n- This is the patient's second gout flare within the past year. \nPlease consider urate lowering therapy in the outpatient setting \n(Uric Acid 10.6 here).\n- Please continue work-up of underlying cirrhosis.\n- Patient being discharged OFF Hydralazine. Please restart in \nthe outpatient setting as appropriate."}}
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{'final_diagnoses': ['Primary Diagnosis: Gout', 'Secondary Diagnosis: Acute-on-Chronic Systolic Heart Failure', 'Acute Kidney Injury'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ year old man with a medical history notable \nfor crystal proven gout and systolic CHF, also with afib s/p \nablation X 2, who presented with a sudden onset of severe \npolyarticular joint pain consistent with a gout flare, and with \na course notable for improvement in toe pain with systemic \nsteroids and diuresis for CHF exacerbation. \n\n#GOUT: Mr. ___ presented with joint pain worse in his ___ \nbilaterally, along with CRP of 49 and in the setting of crystal \nproven gout in ___. Uric Acid also elevated to 10.6. No signs \nofinfection on exam or by vital signs. Patient was previously \nprescribed colchicine but could not find the prescription at \nhome and, given difficulty ambulating and extreme pain, \npresented for further work-up and management. Of note, he \ndeferred colchicine and possible joint aspiration/injection \nduring admission. He preferred steroids though risks/benefits \nwere discussed. Plain film of the feet only notable for edema. \nHe responded well to systemic steroids and is now ready for \ndischarge. He will complete a course of prednisone at home. \n\n#ACUTE-ON-CHRONIC SYSTOLIC HF: EF of 25%. Patient has \ncardiomyopathy with recent exacerbation requiring increased \ndiuresis. Mechanism of his CHF has been felt to be \ntachycardia-mediated cardiomyopathy with MR and TR and severe \npHTN. He presents with BNP elevated to 4700 from ___ over \npast several weeks. Also with weight of 274lbs on admission. Dry \nweight unclear but weights around 257-260lbs recorded recently. \nDischarge weight is 267-270lbs. Patient is being discharged on \nTorsemide 40mg daily (home diuretic dose) given Cr 1.6 on day of \ndischarge.\n\n___ ON CKD: Patient with ___ to 1.6 on mild CKD. His ___ \ninitially improved with diuresis but then increased again to 1.6 \non the day of discharge. This was likely mildly elevated in the \nsetting of near-euvolemia and ongoing diuresis. He will resume \nhis usual home regimen of Torsemide 40mg daily as above.\n\n#pAF: s/p PVI ___ and re-do ablation ___. Carvedilol, \namiodarone and Eliquis were continued during admission.\n\n#IDDM: Patient was continued on home Lantus and Humalog. He also \nreceived a HISS for correction given steroid course.\n\n#HYPERTENSION: Medications continued as above except for \nHydralazine, which was held due to SBP 100-105 during stay.\n\n#CONGESTIVE HEPATOLOGY WITH UNDERLYING NAFLD: Patient has \nelevated bilirubin on admission. He has history of this in past \nas well. Work-up including RUQ U/S and Liver MRI in ___ showed \ncirrhosis. \n\nTRANSITIONAL ISSUES:\n- Patient is being discharged on Torsemide 40mg daily. Weight at \ndischarge is 270 lbs. Patient's lowest weight this admission was \n267 lbs (day prior to discharge).\n- Cr at discharge was 1.6 (this fluctuated between 1.0 and 1.6 \nduring admission). Please recheck Cr and electrolytes within ___ \ndays after discharge.\n- Patient was discharged on a 5-day steroid taper (30mg X 1 more \nday, 20mg X 2 days, 10mg X 2 days then stop). \n- Patient instructed to monitor his blood sugars closely after \nlunch and dinner until follow-up with PCP. He was given a HISS \n(at his request) to use for correction and was instructed to \ncall his primary care provider if blood sugar is greater than \n400 at home. Please stop this once hyperglycemia ___ steroids) \nresolved.\n- This is the patient's second gout flare within the past year. \nPlease consider urate lowering therapy in the outpatient setting \n(Uric Acid 10.6 here).\n- Please continue work-up of underlying cirrhosis.\n- Patient being discharged OFF Hydralazine. Please restart in \nthe outpatient setting as appropriate.", 'medications_prescribed': ['1. PredniSONE 30 mg PO DAILY Duration: 3 Days \nRX *prednisone 10 mg 1 tablet(s) by mouth as directed Disp #*9 \nTablet Refills:*0 ', '2. Glargine 3 Units Bedtime\nHumalog 3 Units Breakfast\nHumalog 3 Units Lunch\nHumalog 3 Units Dinner\nInsulin SC Sliding Scale using HUM Insulin ', '3. Amiodarone 200 mg PO DAILY ', '4. Apixaban 5 mg PO BID ', '5. Carvedilol 25 mg PO BID ', '6. Eplerenone 25 mg PO DAILY ', '7. Torsemide 40 mg PO DAILY ', '8. HELD- HydrALAZINE 100 mg PO TID This medication was held. Do \nnot restart HydrALAZINE until your blood pressure is measured by \nyour PCP/Cardiologist.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 84, 'gender': 'M', 'symptoms': 'cc:neck pain', 'medical_history': ['lynch syndrome', 'breast cancer and colon cancer treated with mastectomy and 3\ncolon surgeries including gsubtotal colectomy and hysterectomy,sees Dr. ___ oncology.', 'PMR, off prednisone for past year, sees Dr. ___ rheum', 'asthma, developed in her ___', 'anxiety', 'HTN (she said pre-hypertension with variable BPs)'], 'family_history': 'not pertinent for management of chief complaint, see oncology\nnote from pedigree.', 'present_illness': '___ with lynch syndrome with remission from breast and \ncolorectal\ncancer who has experienced over four weeks of neck pain. She \nhad\na massage on ___ and the following day had pain in her neck. \nHer pain has been severe, affected her quality of life and has\nrecently changed location. For the first four weeks, her pain\nwas primarily located in the neck and non-radiating, and with\nsome worsening when her head was in extension. She was able to\ncarry on her ADLs but the pain persisted. She was seen by PCP\nand urgent care providers and attended four weeks of physical\ntherapy. Therapies included ibuprofen with some relief of pain\nthough it began to cause stomach distress, Tylenol, and \ntramadol.\nShe limited ibuprofen use and started zantac. \n\nThe pain worsened last week and she went to ___ where she\nhad MRI/MRA spine and neck that showed spondylosis. She had\ntrigger point injections that helped a little bit. Since then\nthe pain has changed to be primarily on the back of her\nscalp/occiput region as well as pain in her jaws that has lead \nto\nher eating softer foods. She denies pain when chewing or pain \nin\nher temporal region. The pain has been knife like at times and\nshe used the phrase unbearable. She was diagnosed with asthma\nexacerbation during about a week ago and treated with a burst \nof\nprednisone which reduced her pain somewhat. \n\nIn the ___ rheumatology consulted. ESR was 140.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': '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': 'Lisinopril', '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': 'IV', 'frequency': 'ONCE', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Furosemide', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', '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': 'Metoprolol Tartrate', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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}]}, 'clinical_findings': {'labs': [{'value': '4.1', 'valuenum': 4.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.5', 'valuenum': 43.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58.9', 'valuenum': 58.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.4', '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, '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': '33.8', 'valuenum': 33.8, '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '13.4', 'valuenum': 13.4, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 75.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 25.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '165000', 'valuenum': 165000.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11500', 'valuenum': 11500.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.0', 'valuenum': 34.0, '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': '214', 'valuenum': 214.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.68', 'valuenum': 3.68, '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': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '___', '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '268', 'valuenum': 268.0, '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': '3.90', 'valuenum': 3.9, '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': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', '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 = 71 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': 192.0, 'valueuom': 'mg/dL', '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '35.4', 'valuenum': 35.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '126', 'valuenum': 126.0, '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': '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': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, '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': 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': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', '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': '34.6', 'valuenum': 34.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '301', 'valuenum': 301.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': '98.4 121/70 76 18 95RA\nwell appearing ambulating aox3 female\nshe has Lidoderm patch on back of neck\nsome prominence of veins in temporal region\nno temporal region tenderness to palpation\nmild discomfort to palpation of posterior scalp in occipital and\nlateral region\nno focal pain to spinous process of her neck or pain to \npalpation\nof her shoulders\nno pain to palpation at jaw\nno severe trismus\nctab\nrrr nmrg\nabd soft non tender no organomegaly\nno peripheral edema \nno visible rashes\nsteady gait\ncalm and cooperative\n\nExam on discharge:\nVitals: 97.9 BP:146 / 70 HR:65R:18O2:94Ra\nGen: NAD, lying in bed in NAD\nEyes: EOMI, PERRLA, sclerae anicteric.\nENT: MMM, OP clear, no TMJ tenderness, no tenderness on \npalpation\nLymph: NO LAD\n___: RRR, no MRG, full pulses, no edema \nResp: normal effort, no accessory muscle use, lungs CTA ___.\nGI: soft, NT, ND, BS+\nMSK: No significant kyphosis. No palpable synovitis.\nSkin: No visible rash. No jaundice.\nNeuro: AAOx3. No facial droop.\nPsych: Full range of affect', 'diagnoses': [{'icd_code': '71916', 'desc': 'Hemarthrosis, lower leg'}, {'icd_code': '27549', 'desc': 'Other disorders of calcium metabolism'}, {'icd_code': '71237', 'desc': 'Chondrocalcinosis, unspecified, ankle and foot'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V433'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'V1083', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'V1272', 'desc': 'Personal history of colonic polyps'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': '___ 01:07PM GLUCOSE-109* UREA N-13 CREAT-0.6 SODIUM-134* \nPOTASSIUM-3.6 CHLORIDE-90* TOTAL CO2-29 ANION GAP-15\n___ 01:07PM estGFR-Using this\n___ 01:07PM CRP-146.5*\n___ 01:07PM WBC-9.0 RBC-3.60* HGB-12.6 HCT-37.7 MCV-105* \nMCH-35.0* MCHC-33.4 RDW-11.7 RDWSD-44.8\n___ 01:07PM NEUTS-65.4 ___ MONOS-8.7 EOS-1.7 \nBASOS-0.3 IM ___ AbsNeut-5.86 AbsLymp-2.12 AbsMono-0.78 \nAbsEos-0.15 AbsBaso-0.03\n___ 01:07PM PLT COUNT-362\n___ with over a month of posterior neck pain after a massage who \nhas since developed jaw pain, scalp tenderness and elevated CRP \nconcerning for giant cell arteritis \n\n#Possible Giant cell arteritis\nPatient with a month of neck pain with current symptoms \nsuggestive of GCA. She was noted to have a significantly \nelevated CRP on admission. CXR was completed and was without \naortic widening. She was seen by rheumatology and started on \nprednisone 60mg daily with significant improvement in symptoms. \nVascular surgery was consulted for temporal artery biopsy which \nwas completed on ___ with results pending on discharge. The \npatient was discharged on Prednisone 60mg daily until follow up \nwith her rheumatologist. She had hepatitis and HIV serologies \nwhich were negative. She was advised to get hepatitis B \nvaccination. Quant gold is pending on discharge. The patient was \nalso discharged on Bactrim for PJP PPX, calcium and vitamin D \nfor bone health and a PPI for dyspepsia. She was started on a \nbaby aspirin to reduce risk of visual loss and CVAs. She was \ncounseled on warning signs which would prompt a call or return \nto the hospital. \n\n#Asthma\nContinued on Advair and albuterol PRN\n\n#Anxiety: chronic stable\nBupropion and Lexapro were continued The patient was given a \nsmall quantity of trazodone for sleep disturbance in the setting \nof steroids. She was counseled on the interaction with trazodone \nand buprioprion. \n\n#Mild Hyponatremia: \nAsymptomatic. HCTZ was held and not resumed on discharge. Would \nconsider alternative antihypertensive as outpatient. \n\n#Macrocytosis\nChronic for years, B12 last checked ___ and 429, has been in \nnormal range since ___'}}
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{'final_diagnoses': ['Giant Cell arteritis'], 'procedures': ['Temporal Artery Biopsy ___'], 'visit_summary': '___ with over a month of posterior neck pain after a massage who \nhas since developed jaw pain, scalp tenderness and elevated CRP \nconcerning for giant cell arteritis \n\n#Possible Giant cell arteritis\nPatient with a month of neck pain with current symptoms \nsuggestive of GCA. She was noted to have a significantly \nelevated CRP on admission. CXR was completed and was without \naortic widening. She was seen by rheumatology and started on \nprednisone 60mg daily with significant improvement in symptoms. \nVascular surgery was consulted for temporal artery biopsy which \nwas completed on ___ with results pending on discharge. The \npatient was discharged on Prednisone 60mg daily until follow up \nwith her rheumatologist. She had hepatitis and HIV serologies \nwhich were negative. She was advised to get hepatitis B \nvaccination. Quant gold is pending on discharge. The patient was \nalso discharged on Bactrim for PJP PPX, calcium and vitamin D \nfor bone health and a PPI for dyspepsia. She was started on a \nbaby aspirin to reduce risk of visual loss and CVAs. She was \ncounseled on warning signs which would prompt a call or return \nto the hospital. \n\n#Asthma\nContinued on Advair and albuterol PRN\n\n#Anxiety: chronic stable\nBupropion and Lexapro were continued The patient was given a \nsmall quantity of trazodone for sleep disturbance in the setting \nof steroids. She was counseled on the interaction with trazodone \nand buprioprion. \n\n#Mild Hyponatremia: \nAsymptomatic. HCTZ was held and not resumed on discharge. Would \nconsider alternative antihypertensive as outpatient. \n\n#Macrocytosis\nChronic for years, B12 last checked ___ and 429, has been in \nnormal range since ___', 'medications_prescribed': ['Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0', 'PredniSONE 60 mg PO 6AM \nRX *prednisone 20 mg 3 tablet(s) by mouth Q6AM Disp #*90 Tablet \nRefills:*0', 'Sulfameth/Trimethoprim SS 1 TAB PO DAILY \nRX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by \nmouth daily Disp #*30 Tablet Refills:*0', 'TraZODone 25 mg PO QHS:PRN insomnia \nRX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth QHS PRN \nINSOMNIA Disp #*10 Tablet Refills:*0', 'Calcium Carbonate 500 mg PO BID', 'albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN', 'Aspirin 81 mg PO DAILY', 'BuPROPion XL (Once Daily) 150 mg PO DAILY', 'Denosumab (Prolia) 60 mg SC ONCE', 'Docusate Sodium 100 mg PO BID', 'Escitalopram Oxalate 20 mg PO DAILY', 'Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', 'Multivitamins W/minerals 1 TAB PO DAILY', 'TraMADol 50 mg PO BID:PRN Pain - Moderate', 'Vitamin D 800 UNIT PO DAILY', 'HELD- Hydrochlorothiazide 25 mg PO DAILY This medication \nwas held. Do not restart Hydrochlorothiazide until you discuss \nwith your primary care doctor']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 77, 'gender': 'F', 'symptoms': 'right abdominal pain', 'medical_history': ['Brainstem stroke in ___', 'R-side hemiparesis, extensive aphasia, dysphagia, ', 'HLD', 'GERD', 'Bilateral nephrolithiasis', 'Glaucoma', 'Colon polyps', 'Skin cancer', 'Depression'], 'family_history': 'Noncontributory', 'present_illness': 'Patient is an ___ w/ h/o brainstem stroke c/b significant\nresidual R-sided hemiparesis, aphasia, dysphagia requiring\nG-tube, who has been transferred from ___ for\nmanagement of cystic duct obstruction and possible \ncholecystitis.\nMr. ___ and his family report that last week he had a\nlow-grade fever, fatigue, and productive cough, for which he was\nseen by his PCP and completed ___ course of azithromycin and\naugmentin for possible pneumonia and/or UTI from recent\ncystoscopy (positive urine culture). He subsequently developed\nnausea and vomiting, and there was some concern for aspiration,\nso he was admitted through the Emergency Department to ___ on ___ for management of aspiration pneumonia. \n\nAt ___, CXR demonstrated LLL consolidation, CBC and BMP\nwnl, and lactate of 2.7. He was started on zosyn and levaquin,\nand infectious disease was consulted. On ___ he complained\nof right-sided abdominal pain worse with cough, and had brown\nsputum with bile-like taste. On ___, he underwent a chest \nCT\nto evaluate his pneumonia, which demonstrated consolidation in\nbilateral lower lobes, L>R, frothy material within bronchial\nsegments likely representing aspirated material, distended\ngallbladder with mild wall thickening and small pericholecystic\nfluid, and hiatal hernia. He then had a RUQ U/S that \ndemonstrated\nmultiple gallstones and small pericholecystic fluid in\ngallbladder, no wall thickening or sonographic ___ sign.\nLFTs wnl except for alkaline phosphatase of 147. Surgery was\nconsulted, and a HIDA scan was performed, which demonstrated\nnonfilling of the gallbladder consistent with cystic duct\nobstruction and Cholecystitis in the appropriate clinical\nsetting. \n\nGiven the likely diagnosis of concomitant Cholecystitis and\naspiration pneumonia, it was decided that Mr. ___ be\ntransferred to ___ for further care to decide whether a\npercutaneous cholecystotomy tube vs lap cholecystectomy would be\nmost appropriate at this time. Upon evaluation on admission, Mr.\n___ appears frail but in no acute distress. He is \nafebrile,\nhis vitals are WNL, and his abdominal exam is soft and\ndemonstrates mild RUQ TTP only. He denies chills, SOB, chest\npain, headaches, light-headedness, dysuria, changes in bowel\nmovements. His ROS was otherwise negative.', 'medications': [{'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': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levalbuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', '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': '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': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H: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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS: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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Viscous 2%', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins W/minerals', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levalbuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q2H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levalbuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', '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': 'TraZODone', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', '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': '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': 'Levalbuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Hydrocortisone Cream 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', '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 via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'QHS: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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TD', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 3% Inhalation Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'BID: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': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'IV DRIP', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', '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': 'Diltiazem Extended-Release', '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': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Viscous 2%', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', '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': 'HYDROmorphone (Dilaudid)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', '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': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'GuaiFENesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . estimated GFR (eGFR) is likely between 70 and >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 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', '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': '2.0', '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': '___', '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': 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': '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}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, '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': '33.2', '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': '373', 'valuenum': 373.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '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': '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': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '>1.050*.'}, {'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': '/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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 22.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 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'ref_range_upper': 40.0, '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': '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': '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '31', 'valuenum': 31.0, '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': '328', 'valuenum': 328.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 747.0, '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': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '___', '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': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': 'abnormal', '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': '-6', 'valuenum': -6.0, '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': '1.6', 'valuenum': 1.6, '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': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': 'VEN.', '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': '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': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '127', 'valuenum': 127.0, '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': 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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'SM*.'}, {'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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '36', 'valuenum': 36.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '1.028', 'valuenum': 1.028, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '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': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 5.6, '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': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '389', 'valuenum': 389.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '-5', 'valuenum': -5.0, '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': '1.6', 'valuenum': 1.6, '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': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': 'VEN.', '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': '23', 'valuenum': 23.0, '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': '1.4', 'valuenum': 1.4, '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': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '562', 'valuenum': 562.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, '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': '20', 'valuenum': 20.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, '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': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': 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': '___', '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, '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': '1.34', 'valuenum': 1.34, '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': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '7.2', 'valuenum': 7.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.5', 'valuenum': 82.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '1.11', 'valuenum': 1.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.64', 'valuenum': 12.64, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '48.3', 'valuenum': 48.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-5', 'valuenum': -5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '577', 'valuenum': 577.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '386', 'valuenum': 386.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.0', 'valuenum': 47.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2, . estimated GFR (eGFR) is likely between 44 and 53 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': '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': '230', 'valuenum': 230.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': 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': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, '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': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', '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': '8.3', 'valuenum': 8.3, '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': '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': 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': '11', 'valuenum': 11.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': 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': '___', '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': '37', 'valuenum': 37.0, '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': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '391', 'valuenum': 391.0, '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': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.7', 'valuenum': 47.7, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm 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'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.5, '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': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '1.04', 'valuenum': 1.04, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'OCCASIONAL*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, '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': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', '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': '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': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '416', 'valuenum': 416.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '14.3', 'valuenum': 14.3, 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'flag': None, 'priority': None, 'comments': '___'}, {'value': '10', 'valuenum': 10.0, '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': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 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'comments': None}, {'value': '362', 'valuenum': 362.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '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': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '391', 'valuenum': 391.0, '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': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48.7', 'valuenum': 48.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, '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': '20', 'valuenum': 20.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', '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': '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': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, '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': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals- 97.8 84 104/69 18 99RA\nGeneral- weak-appearing male in no acute distress\nChest- no increased work of breathing, bibasilar crackles\nCardiac-RRR\nAbd-soft, non-tender, non-distended. G-tube in place with \ndressing c/d/I. RUQ incision with steri-strips open to air. \nExt- WWP, no edema', 'diagnoses': [{'icd_code': 'C786', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'C251', 'desc': 'Malignant neoplasm of body of pancreas'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'G92', 'desc': 'Toxic encephalopathy'}, {'icd_code': 'Z515', 'desc': 'Encounter for palliative care'}, {'icd_code': 'R180', 'desc': 'Malignant ascites'}, {'icd_code': 'E46', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': 'Z6824', 'desc': 'Body mass index [BMI] 24.0-24.9, adult'}, {'icd_code': 'I82890', 'desc': 'Acute embolism and thrombosis of other specified veins'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'T402X5A', 'desc': 'Adverse effect of other opioids, initial encounter'}, {'icd_code': 'T471X5A', 'desc': 'Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter'}, {'icd_code': 'Y92019', 'desc': 'Unspecified place in single-family (private) house as the place of occurrence of the external cause'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'I4892', 'desc': 'Unspecified atrial flutter'}, {'icd_code': 'K521', 'desc': 'Toxic gastroenteritis and colitis'}, {'icd_code': 'M5136', 'desc': 'Other intervertebral disc degeneration, lumbar region'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'K5909', 'desc': 'Other constipation'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'K1120', 'desc': 'Sialoadenitis, unspecified'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'E861', 'desc': 'Hypovolemia'}, {'icd_code': 'I2720', 'desc': 'Pulmonary hypertension, unspecified'}], 'summary': "___ RUQ ultrasound:\nBILE DUCTS: There is no intrahepatic biliary dilation. The CHD \nmeasures 8 mm. \nGALLBLADDER: The gallbladder contains extensive sludge or debris \nand is \nmoderately distended. The gallbladder wall appears irregular. \nThere are \nareas of gallbladder wall thickening. The margins between the \ngallbladder and liver are indistinct on some images. \nIMPRESSION: \n1. Moderate gallbladder distention with sludge and small stones \nand areas of wall thickening is concerning for cholecystitis, \nespecially given the outside HIDA scan. \n2. Wall thinning and irregularity raises the possibility of \ngangrenous \ncholecystitis. \n3. No bile duct dilation. \n\n___ CT abdomen/pelvis:\nIMPRESSION: \n1. Findings compatible with ruptured hemorrhagic gangrenous \ncholecystitis. An underlying mass lesion cannot be entirely \nexcluded. \n2. Small volume intraperitoneal ascites. \n3. Very large hiatal hernia. \n4. Bilateral lower lobe collapse and small effusions. \n5. Possible small calcified celiac artery aneurysm. \n\n___ CT chest:\n1. Left IJ central venous catheter appears to terminate at the \nconfluence of the left brachiocephalic vein and the SVC. Mild \nstreak artifact slightly limits evaluation of its position, but \nit appears to be intraluminal throughout its course. If normal \nvenous waveforms are detected or venous blood is readily \nsampled, this could be advanced gently by 3-4 cm to terminate \nwithin the mid to low SVC. \n2. Bilateral lower lobe collapse, with superimposed lower lobe \nconsolidation not excluded. Scattered areas of ground-glass \nthroughout the aerated lungs are consistent with the provided \nhistory of pneumonia. \n3. Interval placement of a drainage catheter into the collection \nin the \ngallbladder fossa, which is nearly entirely decompressed with \nexpected \nassociated pneumoperitoneum. \n\n___ RUQUS:\n1. No intra or extrahepatic biliary dilatation identified. No \nperihepatic \nfluid collections identified. \n2. A moderate right pleural effusion is noted. \n\n___ CT torso:\nChest- Worsened patchy nodular, ground-glass pulmonary \nopacities, worrisome for infection. Improved bilateral lower \nlobe atelectasis, more prominent on the left. Bilateral pleural \neffusions, partially loculated on the left, mildly worsened \nsince prior. \nAbd/pelvis- 1. Postsurgical changes from recent cholecystectomy. \n Fluid collection in the gallbladder fossa may be postoperative, \nearly forming abscess or bile leak cannot be ruled out and \nfollow-up imaging as clinically indicated can be performed. \n2. PEG tube is noted with its distal tip abutting anterior \ngastric wall, is probably intraluminal, clinically correlate \nconfirm its position and proper function.\nThe patient initially presented to OSH with aspiration pneumonia \nand his course was complicated by the development of abdominal \npain; HIDA imaging diagnosed acute cholecystitis. The patient \nwas therefore transferred to ___ the evening of ___ for \nsurgical management and planned cholecystectomy on ___. \nThe patient was initially stable and treated with IV zosyn in \nanticipation of surgery. However, on the evening of ___, the \npatient started to acutely decompensate. He triggered for \ntachycardia to 130 and hypotension with SBP in ___. He received \n1L of fluid resuscitation with HR response to 105-110 but his \nSBP only improved to the mid-80s. EKG demonstrated sinus \ntachycardia; labwork was notable for negative troponins, WBC \n12.7 from 11, TBR 2.9 from 1.0, Alk phosph 391 from 187, and \nincreased mild transaminitis. Given his hemodynamic instability \nand trend in lab abnormalities, he was transferred to the SICU \nat this time due to concern for sepsis secondary to cholangitis. \nHis antibiotics were broadened to vanc/zosyn. Fluid \nrescusitation continued and he underwent repeat RUQ ultrasound \novernight which showed persistent findings of cholecystitis but \nno CBD dilation or cholodocholithiasis to suggest cholangitis. \nDespite fluid resuscitation, he continued to be hypotensive and \nwas started on pressors with placement of a central and A-line. \nOnce stabilized on pressors, he was taken for a CT \nabdomen/pelvis which demonstrated a hemorrhagic, perforated \ngallbladder. He was then taken urgently to the operating room \nfor open cholecystectomy with evacuation of hematoma. \nIntraoperatively, he received 4U pRBC, 1U FFP, and 1U platelets. \nPost-operatively, he returned to the SICU, remaining intubated \nand requiring higher does of levophed. Over the following days, \nfluid rescusitation continued with improved lactate (4.7-> \n1.3->0.9), allowing pressors to be gradually weaned to 0.08. His \nhematocrit decreased from 30 to 23 to 21 prior to stabilizing at \n23, reflecting a likely dilutional process. He did not receive \nadditional blood transfusion post-operatively. His TBR \ndowntrended appropriately to normal levels. \n\nThe patient's g-tube feeds were restarted on POD3, which were \ntolerated well throughout the remainder of the course. There \nwere multiple attempts to extubate the patient over the first \nweek post-operatively that were complicated by fluid overload \nfrom his initial fluid resuscitation and his underlying \npneumonia. He therefore underwent diuresis with a Lasix drip for \nseveral days in an attempt to optimize his respiratory status \nprior to trialing extubation. By POD6, however, he remained \nintubated due to failed spontaneous breathing trials and on \nlevophed (at 0.15, which had increased since starting diuresis \nfrom 0.08). Bronchoscopy was performed which was normal; BAL was \nobtained that was positive for MRSA. At this time, his \nantibiotics were narrowed from vanc/zosyn to vanc and he \nremained afebrile. He then underwent repeat CT torso imaging \nwhich demonstrated bilateral pulmonary ground-glass opacities \nconsistent with aspiration pneumonia, bilateral pleural \neffusions, and a likely post-operative collection in the \ngallbladder fossa. He was ultimately extubated on POD8 to \nhigh-flow nasal cannula and then he transitioned to nasal \ncannula. He underwent aggressive chest physical therapy with \nimprovement in his chest xrays and did well on room air.\n\nHe was ultimately weaned off pressors on POD9 after being \nstarted on 5mg midodrine TID on POD8. He was then transferred to \nthe floor on POD10 and remained stable. He continued to work \nwith physical therapy. He completed a 7-day course of \nvancomycin on POD10 for his MRSA pneumonia. His midodrine was \ngradually weaned to 2.5mg BID, which he initially tolerated. \n\nWhile preparing for discharge on POD12, however, he became \nacutely tachycardic and then developed hypotension with a new \nleukocytosis. He was restarted on vancomycin/zosyn. He was \ntransferred back to the ICU and started on low-dose \nneosynephrine. His midodrine was increased back to 5mg TID. He \nunderwent CT torso which demonstrated multifocal pneumonia, \nsmall bilateral pleural effusions, and a small collection in the \ngallbladder fossa. ___ was consulted for drainage of the \ngallbladder fossa which was ultimately sterile and the drain was \nremoved two days later. Thoracentesis of the pleural effusions \nby interventional pulmonology was considered but ultimately felt \nto be of low yield given improvement on serial imaging and the \nsmall size of the collections. The patient weaned off pressors \nwithin ___ days after re-starting antibiotics and subsequently \nremained hemodynamically stable on midodrine 5mg TID. \n\nHe returned to the floor on POD17 where he continued frequent \nchest physical therapy and physical therapy. He was deemed \nappropriate for discharge home with 24-hour services and aids to \nperform chest therapy. His antibiotics were switched to oral \nlevofloxacin/bactrim to complete a total 14-day course of \nantibiotics combined since his admission, which will end on the \nevening of ___ (the night of discharge). He tolerated his usual \nhome regimen of gtube feeds prior to discharge. He remained \nhemodynamically stable."}}
|
{'final_diagnoses': ['aspiration pneumonia', 'sepsis', 'hemorrhagic cholecystitis ', 'gallbladder rupture', 'pulmonary edema'], 'procedures': ['Open cholecystectomy, evacuation of hematoma and retrieval \nof ruptured gallbladder stones.'], 'visit_summary': "The patient initially presented to OSH with aspiration pneumonia \nand his course was complicated by the development of abdominal \npain; HIDA imaging diagnosed acute cholecystitis. The patient \nwas therefore transferred to ___ the evening of ___ for \nsurgical management and planned cholecystectomy on ___. \nThe patient was initially stable and treated with IV zosyn in \nanticipation of surgery. However, on the evening of ___, the \npatient started to acutely decompensate. He triggered for \ntachycardia to 130 and hypotension with SBP in ___. He received \n1L of fluid resuscitation with HR response to 105-110 but his \nSBP only improved to the mid-80s. EKG demonstrated sinus \ntachycardia; labwork was notable for negative troponins, WBC \n12.7 from 11, TBR 2.9 from 1.0, Alk phosph 391 from 187, and \nincreased mild transaminitis. Given his hemodynamic instability \nand trend in lab abnormalities, he was transferred to the SICU \nat this time due to concern for sepsis secondary to cholangitis. \nHis antibiotics were broadened to vanc/zosyn. Fluid \nrescusitation continued and he underwent repeat RUQ ultrasound \novernight which showed persistent findings of cholecystitis but \nno CBD dilation or cholodocholithiasis to suggest cholangitis. \nDespite fluid resuscitation, he continued to be hypotensive and \nwas started on pressors with placement of a central and A-line. \nOnce stabilized on pressors, he was taken for a CT \nabdomen/pelvis which demonstrated a hemorrhagic, perforated \ngallbladder. He was then taken urgently to the operating room \nfor open cholecystectomy with evacuation of hematoma. \nIntraoperatively, he received 4U pRBC, 1U FFP, and 1U platelets. \nPost-operatively, he returned to the SICU, remaining intubated \nand requiring higher does of levophed. Over the following days, \nfluid rescusitation continued with improved lactate (4.7-> \n1.3->0.9), allowing pressors to be gradually weaned to 0.08. His \nhematocrit decreased from 30 to 23 to 21 prior to stabilizing at \n23, reflecting a likely dilutional process. He did not receive \nadditional blood transfusion post-operatively. His TBR \ndowntrended appropriately to normal levels. \n\nThe patient's g-tube feeds were restarted on POD3, which were \ntolerated well throughout the remainder of the course. There \nwere multiple attempts to extubate the patient over the first \nweek post-operatively that were complicated by fluid overload \nfrom his initial fluid resuscitation and his underlying \npneumonia. He therefore underwent diuresis with a Lasix drip for \nseveral days in an attempt to optimize his respiratory status \nprior to trialing extubation. By POD6, however, he remained \nintubated due to failed spontaneous breathing trials and on \nlevophed (at 0.15, which had increased since starting diuresis \nfrom 0.08). Bronchoscopy was performed which was normal; BAL was \nobtained that was positive for MRSA. At this time, his \nantibiotics were narrowed from vanc/zosyn to vanc and he \nremained afebrile. He then underwent repeat CT torso imaging \nwhich demonstrated bilateral pulmonary ground-glass opacities \nconsistent with aspiration pneumonia, bilateral pleural \neffusions, and a likely post-operative collection in the \ngallbladder fossa. He was ultimately extubated on POD8 to \nhigh-flow nasal cannula and then he transitioned to nasal \ncannula. He underwent aggressive chest physical therapy with \nimprovement in his chest xrays and did well on room air.\n\nHe was ultimately weaned off pressors on POD9 after being \nstarted on 5mg midodrine TID on POD8. He was then transferred to \nthe floor on POD10 and remained stable. He continued to work \nwith physical therapy. He completed a 7-day course of \nvancomycin on POD10 for his MRSA pneumonia. His midodrine was \ngradually weaned to 2.5mg BID, which he initially tolerated. \n\nWhile preparing for discharge on POD12, however, he became \nacutely tachycardic and then developed hypotension with a new \nleukocytosis. He was restarted on vancomycin/zosyn. He was \ntransferred back to the ICU and started on low-dose \nneosynephrine. His midodrine was increased back to 5mg TID. He \nunderwent CT torso which demonstrated multifocal pneumonia, \nsmall bilateral pleural effusions, and a small collection in the \ngallbladder fossa. ___ was consulted for drainage of the \ngallbladder fossa which was ultimately sterile and the drain was \nremoved two days later. Thoracentesis of the pleural effusions \nby interventional pulmonology was considered but ultimately felt \nto be of low yield given improvement on serial imaging and the \nsmall size of the collections. The patient weaned off pressors \nwithin ___ days after re-starting antibiotics and subsequently \nremained hemodynamically stable on midodrine 5mg TID. \n\nHe returned to the floor on POD17 where he continued frequent \nchest physical therapy and physical therapy. He was deemed \nappropriate for discharge home with 24-hour services and aids to \nperform chest therapy. His antibiotics were switched to oral \nlevofloxacin/bactrim to complete a total 14-day course of \nantibiotics combined since his admission, which will end on the \nevening of ___ (the night of discharge). He tolerated his usual \nhome regimen of gtube feeds prior to discharge. He remained \nhemodynamically stable.", 'medications_prescribed': ['Acetaminophen (Liquid) 650 mg PO Q6H \nDo not exceed 3500mg in one day', 'Docusate Sodium 100 mg PO BID \nHold for loose stools', 'GuaiFENesin 10 mL PO Q6H \nRX *guaifenesin 100 mg/5 mL 10 mL by mouth every 6 hours Disp \n#*1200 Milliliter Refills:*0', 'Midodrine 5 mg PO TID \nYour primary care physician ___ help you slowly wean off this \nmedication. \nRX *midodrine 5 mg 1 tablet(s) by mouth three times a day Disp \n#*90 Tablet Refills:*0', 'Senna 8.6 mg PO BID \nHold for loose stools', 'Sulfameth/Trimethoprim DS 1 TAB PO/NG BID Duration: 3 Days \nRX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by \nmouth once Disp #*1 Tablet Refills:*0', 'Aspirin 81 mg PO DAILY', 'Baclofen 5 mg PO BID', 'Glycopyrrolate 1 mg PO TID', 'Omeprazole 20 mg PO DAILY', 'PARoxetine 10 mg PO DAILY', 'Simvastatin 20 mg PO QPM']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 31, 'gender': 'F', 'symptoms': 'Leg swelling, diarrhea, fever', 'medical_history': ['- Tonsillitis s/p tonsillectomy. ', '- Intermittent asthma, not currently on rescue inhaler', '- Syphilis earlier this year. Thinks "it was caught early." Prescribed a non-penicillin antibiotic for 28 days in ___'], 'family_history': 'Grandfather with prostate cancer. DM\ngrandmother. ___ are healthy', 'present_illness': "Mr. ___ is a ___ yo M with a PMHx\nof intermittent asthma, Syphilis and PCN allergy who presents\nwith 24 hours of LLE pain, swelling and diarrhea.\n\nPatient lives in ___ but is here for the next year on\nsabbatical. He arrived from ___ on ___ and was in normal\nstate of health until ___ where he describes waking up with\nsignificant LLE swelling and painful rash as well as diarrhea.\nPain is ___ but worse with standing. He denies any trauma to \nthe\nleg recently but has had an area of itching and breaking skin on\nhis posteromedial calf for at least a few weeks and suffers from\nmild athlete's foot at baseline. He had 5 watery, explosive\nstools on ___ as well, non-bloody, non-purulent. \n\nHe has hx of syphilis treated with non-penicillin abx in ___. He\nalso has had unprotected sex with men, most recently 10 days \nago.\nHe tested negative for HIV in ___. He has taken acetaminophen \nand\ncough drops for his symptoms which he thinks has helped. \n\nIn ED initial vitals were temp 98.4 Tm 102.9 HR 120 BP 155/101 \nRR\n20 96% RA \n\nExam notable for: no wheezing with auscultation, tachycardic\nLLE with erythema and edema of right lower leg with erythematous\npetechial rash over anterior and posterior lower leg. \n\nLabs showed: WBC 12.5 Cr 1.3 \n\nCTA (given tachycardia and leg swelling): No evidence of\npulmonary embolism or acute aortic abnormality.\n___: No evidence of deep venous thrombosis in the left lower\nextremity veins. \nCXR: Patchy left base opacity most likely atelectasis, but\npneumonia is not excluded in the appropriate clinical setting. \n\nReceived:\n___ 21:38 PO Acetaminophen 1000 mg ___ \n___ 21:38 IVF NS ___ Started \n___ 23:25 IV Vancomycin ___ Started \n___ 23:25 IVF NS 1000 mL ___ Stopped (1h ___ \n\n___ 23:25 IVF NS 1000 mL ___ \n___ 23:55 PO Ibuprofen 600 mg ___ \n___ 00:25 IV Vancomycin 1000 mg ___ Stopped (1h\n___ \n___ 00:48 IV Levofloxacin 750 mg ___ \n\nTransfer VS were: Temp 98.0 HR 95 BP 117/79 RR 18 SaO2 99% RA \n\nOn arrival to the floor, patient reports the above history. He\ncontinues to have ___ LL pain. Last BM was morning of ___, \ndiarrhea has slowed down. Denies SOB, cough, sputum production,\nHA, visual", 'medications': [{'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Baclofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'QHS: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': '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', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Baclofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, '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': '90', 'valuenum': 90.0, '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': 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': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': 'BY DRVVT AND SILICA CLOTTING TIME.'}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW ASSAY IN USE ___: DETECTS D2 AND D3 25-OH ACCURATELY.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 23.2, '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': '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': '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': '11.4', 'valuenum': 11.4, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, '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': '225', 'valuenum': 225.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '449', 'valuenum': 449.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': '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': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'AVAILABLE AT THE ___ LAB.'}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '343', 'valuenum': 343.0, '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': '3.95', 'valuenum': 3.95, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, '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': '17', 'valuenum': 17.0, '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': '9.5', 'valuenum': 9.5, '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': '___', '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 33.0, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 23.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'MEASURED BY ___ VERSION 2;WHICH IS LARGELY UNAFFECTED BY MACROPROLACTIN.'}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, '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}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '362', 'valuenum': 362.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.0', 'valuenum': 47.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, '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': 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': 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': '195', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1699', 'valuenum': 1699.0, 'valueuom': 'mg/dL', 'ref_range_lower': 700.0, 'ref_range_upper': 1600.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 40.0, 'ref_range_upper': 230.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO SPECIFIC ABNORMALITIES SEEN. BASED ON IFE (SEE SEPARATE REPORT),. NO MONOCLONAL IMMUNOGLOBULIN SEEN. INTERPRETED BY ___.'}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, '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': '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': 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': '4.3', 'valuenum': 4.3, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '28.8', 'valuenum': 28.8, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.64', 'valuenum': 3.64, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS: Temp 98.6 BP 153/86 HR 88 RR 18 94%Ra \nGENERAL: Well appearing overweight gentleman NAD. AAOx3.\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,\nMMM\nNECK: supple, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: nondistended, nontender in all quadrants, no\nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: LLE with erythematous rash, TTP, edema. Macerated\ntissue between digits LLE consistent with mild tinea pedis\nPULSES: 2+ DP pulses bilaterally \nNEURO: A&Ox3, moving all 4 extremities with purpose \nSKIN: warm and well perfused, no excoriations or lesions, no\nrashes \n\nDISCHARGE PHYSICAL EXAM:\nVITALS: 98.9 ___\nGENERAL: Well appearing, NAD. AAOx3.\nHEENT: Normocephalic, atraumatic.\nHEART: Regular rate & rhythm. No murmurs.\nLUNGS: CTAB\nABDOMEN: Soft, non-tender, non-distended\nEXTREMITIES: LLE with warm, erythematous rash spanning anterior\nshin and extending around leg with moderately defined borders.\nErythema is expanding beyond lines drawn. Mild 1+ pitting edema\nof LLE spreading to dorsum of foot. Tender, enlarged left\ninguinal LN', 'diagnoses': [{'icd_code': '3369', 'desc': 'Unspecified disease of spinal cord'}, {'icd_code': '7961', 'desc': 'Abnormal reflex'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': 'V463'}, {'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}, {'icd_code': '3441', 'desc': 'Paraplegia'}, {'icd_code': '78830', 'desc': 'Urinary incontinence, unspecified'}, {'icd_code': '78760', 'desc': 'Full incontinence of feces'}, {'icd_code': '6260', 'desc': 'Absence of menstruation'}, {'icd_code': '3361', 'desc': 'Vascular myelopathies'}], 'summary': "ADMISSION LABS:\n___ 09:15PM BLOOD WBC-12.5* RBC-4.99 Hgb-14.6 Hct-43.8 \nMCV-88 MCH-29.3 MCHC-33.3 RDW-13.9 RDWSD-45.1 Plt ___\n___ 09:15PM BLOOD Neuts-79.5* Lymphs-13.3* Monos-6.1 \nEos-0.2* Baso-0.2 Im ___ AbsNeut-9.90* AbsLymp-1.65 \nAbsMono-0.76 AbsEos-0.02* AbsBaso-0.03\n___ 09:15PM BLOOD Plt ___\n___ 09:15PM BLOOD Glucose-123* UreaN-17 Creat-1.3* Na-138 \nK-4.1 Cl-98 HCO3-23 AnGap-17*\n___ 07:15AM BLOOD Calcium-8.7 Phos-3.2 Mg-1.9\n___ 09:26PM BLOOD Lactate-1.9\n\nPERTINENT LABS:\n___ 08:00PM BLOOD HIV1 VL-NOT DETECT\n\nDISCHARGE LABS:\n___ 05:42AM BLOOD WBC-10.5* RBC-4.64 Hgb-13.7 Hct-41.7 \nMCV-90 MCH-29.5 MCHC-32.9 RDW-13.8 RDWSD-44.8 Plt ___\n___ 05:42AM BLOOD Plt ___\n___ 05:42AM BLOOD Glucose-93 UreaN-16 Creat-1.0 Na-139 \nK-4.6 Cl-101 HCO3-23 AnGap-15\n___ 05:42AM BLOOD Calcium-9.4 Phos-4.9* Mg-2.1\n\nMICRO:\n__________________________________________________________\n___ 7:53 am STOOL CONSISTENCY: LOOSE Source: \nStool. \n\n **FINAL REPORT ___\n\n FECAL CULTURE (Final ___: \n NO ENTERIC GRAM NEGATIVE RODS FOUND. \n NO SALMONELLA OR SHIGELLA FOUND. \n\n CAMPYLOBACTER CULTURE (Final ___: NO CAMPYLOBACTER \nFOUND. \n\n FECAL CULTURE - R/O VIBRIO (Final ___: NO VIBRIO \nFOUND. \n\n FECAL CULTURE - R/O YERSINIA (Final ___: NO YERSINIA \nFOUND. \n\n FECAL CULTURE - R/O E.COLI 0157:H7 (Final ___: \n NO E.COLI 0157:H7 FOUND. \n__________________________________________________________\n___ 7:53 am STOOL CONSISTENCY: LOOSE Source: \nStool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Cepheid nucleic \nacid\n amplification assay..\n (Reference Range-Negative). \n__________________________________________________________\n___ 7:15 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 2:40 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 9:00 am BLOOD CULTURE #1. \n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 7:15 am SEROLOGY/BLOOD\n\n **FINAL REPORT ___\n\n RPR w/check for Prozone (Final ___: \n NONREACTIVE. \n Reference Range: Non-Reactive. \n__________________________________________________________\n___ 1:50 am URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n__________________________________________________________\n___ 11:00 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n__________________________________________________________\n___ 9:15 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: \n BACILLUS SPECIES; NOT ANTHRACIS. \n Isolated from only one set in the previous five days. \n\n Anaerobic Bottle Gram Stain (Final ___: \n Reported to and read back by ___. ___ ON ___ \nAT 0230. \n GRAM POSITIVE ROD(S).\n___ male with PMHx of treated Syhphilis presenting for \nLLE rash with associated fevers and diarrhea as well as LLE \nrash, with BCx notable for Bacillus in ___ anaerobic bottles.\n\n#LLE rash\nMost likely infectious etiology, i.e. cellulitis given \nintermittent fevers and positive BCx for Bacillus (not \nanthracis). Infectious disease thought that cellulitis and \nbacteremia were two seperate processes but possible that \nbacteremia seeding his leg leading to cellulitis. Given concern \nfor deep tissue\ninfection/necrosis, CT-leg completed ___ which showed no \nevidence of gas. Surgery saw the patient and do not think it is \nwas nec fasc. TTE negative for valvular vegetations. Patient \nreceived vancomycin and levofloxacin (due to concern for Vibrio \nas patient from ___ on admission. Levofloxacin was then \nd/ced. Due to persistent fevers, high risk sexual history, \npetechial regions of the rash inconsistent with cellulitis, and \nthe prior hx of syphillis, there was concern for a more \ninsidious process. Therefore, patient broaded to vancomycin, \nmeropenem, clindamycin, and doxycycline per ID's \nrecommendations. However, when bacilus grew in the blood, Abx \ntitrated down to only vancomycin. Pt needed a PICC line ___ \ngiven IV access, which was dc'd prior to discharge. On ___, pt \ntransitioned to linezolid ___ mg PO/NG Q12H until ___ (two \nweek course) for coverage of bacillus, staph, and strep. Given \npatient's documented antibiotic allergy, unclear source of his \ninfection, potential for multi-organism infection and potential \nfor more than one infectious process, the decision was made to \nprovide broad coverage with linezolid per discussion with \nInfectious Disease service. ___, ANCA, Gc/C, RPR, and HIV \nnegative. CRP 136 so evidence of inflammation but CK WNL. ESR \nnml. HIV VL undetectable on discharge.\n\n#bloodstream infection, Bacillus non anthracis sps.\nMost likely due to either cellulitis (discussed above) in \nsetting of LLE rash vs. GI source vs. blood culture contaminant. \nTreatment as above. TTE ___ was negative for vegetations. ID \nrecommended treatment as above.\n\n#Congestion on CXR: Pt with mild pulmonary vascular congestion \non CXR ___ and with persistent cough; thought to be secondary \nto volume overload in the setting of receiving fluids this \nhospitalization. Pt given 20mg IV Lasix ___ and responded \nwell. Pt had EF >55% on TTE, which was done to r/o endocarditis. \nAsthma felt to be unlikely.\n\n#diarrhea: multiple episodes diarrhea. C. diff negative. Likely \n___ to infeciton vs. antibiotics. Stool studies (including \nsalmonella/Yersinia/shigella and vibrio were negative.\n\nCHRONIC ISSUES:\n===============\n# Asthma: stable. we contined his albuterol nebs PRN"}}
|
{'final_diagnoses': ['-cellulitis', '-bacillus baceremia', '-diarrhea', '-asthma'], 'procedures': ['N/A'], 'visit_summary': "___ male with PMHx of treated Syhphilis presenting for \nLLE rash with associated fevers and diarrhea as well as LLE \nrash, with BCx notable for Bacillus in ___ anaerobic bottles.\n\n#LLE rash\nMost likely infectious etiology, i.e. cellulitis given \nintermittent fevers and positive BCx for Bacillus (not \nanthracis). Infectious disease thought that cellulitis and \nbacteremia were two seperate processes but possible that \nbacteremia seeding his leg leading to cellulitis. Given concern \nfor deep tissue\ninfection/necrosis, CT-leg completed ___ which showed no \nevidence of gas. Surgery saw the patient and do not think it is \nwas nec fasc. TTE negative for valvular vegetations. Patient \nreceived vancomycin and levofloxacin (due to concern for Vibrio \nas patient from ___ on admission. Levofloxacin was then \nd/ced. Due to persistent fevers, high risk sexual history, \npetechial regions of the rash inconsistent with cellulitis, and \nthe prior hx of syphillis, there was concern for a more \ninsidious process. Therefore, patient broaded to vancomycin, \nmeropenem, clindamycin, and doxycycline per ID's \nrecommendations. However, when bacilus grew in the blood, Abx \ntitrated down to only vancomycin. Pt needed a PICC line ___ \ngiven IV access, which was dc'd prior to discharge. On ___, pt \ntransitioned to linezolid ___ mg PO/NG Q12H until ___ (two \nweek course) for coverage of bacillus, staph, and strep. Given \npatient's documented antibiotic allergy, unclear source of his \ninfection, potential for multi-organism infection and potential \nfor more than one infectious process, the decision was made to \nprovide broad coverage with linezolid per discussion with \nInfectious Disease service. ___, ANCA, Gc/C, RPR, and HIV \nnegative. CRP 136 so evidence of inflammation but CK WNL. ESR \nnml. HIV VL undetectable on discharge.\n\n#bloodstream infection, Bacillus non anthracis sps.\nMost likely due to either cellulitis (discussed above) in \nsetting of LLE rash vs. GI source vs. blood culture contaminant. \nTreatment as above. TTE ___ was negative for vegetations. ID \nrecommended treatment as above.\n\n#Congestion on CXR: Pt with mild pulmonary vascular congestion \non CXR ___ and with persistent cough; thought to be secondary \nto volume overload in the setting of receiving fluids this \nhospitalization. Pt given 20mg IV Lasix ___ and responded \nwell. Pt had EF >55% on TTE, which was done to r/o endocarditis. \nAsthma felt to be unlikely.\n\n#diarrhea: multiple episodes diarrhea. C. diff negative. Likely \n___ to infeciton vs. antibiotics. Stool studies (including \nsalmonella/Yersinia/shigella and vibrio were negative.\n\nCHRONIC ISSUES:\n===============\n# Asthma: stable. we contined his albuterol nebs PRN", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild', 'Linezolid ___ mg PO Q12H \nRX *linezolid ___ mg 1 tablet(s) by mouth twice daily Disp #*19 \nTablet Refills:*0', 'Crutches\nCrutches\nR26.2, Difficulty in walking, not elsewhere classified\nDME\nPrognosis: good Duration: 13 months']}
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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': '___ with known C2 lytic lesion presents for prop work up in\nanticipation of Occiput to C6 fusion. Pt has been grossly \nstable\nat rehab, no new focal weakness but notes general overall\nworsening of weakness in hands and legs. He presents for \nPosterior occiputal C6 fusion & C1-C2& C5-C6 laminectomy.', 'medical_history': ['- CHF EF 30% s/p pacer (placed ___', '- Afib', '- HTN', '- Rheumatoid arthritis, not on IMDs', '- Laryngeal cancer (unsure of type) ___ years ago s/p radiation\ntherapy only, in remission', '- s/p bilateral cataract surgeries'], 'family_history': 'Non-contributory', 'present_illness': 'HPI: ___ with known C2 lytic lesion. Pt has been grossly stable\nat rehab, no new focal weakness but noted general overall\nworsening of weakness in hands and legs. He presented for \nocciput to C6 fusion.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DINNER', '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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ONCE', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . Estimated GFR = 71 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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '44', 'valuenum': 44.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, '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': 'STAT', 'comments': None}, {'value': '-82', 'valuenum': -82.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-53', 'valuenum': -53.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, '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': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 39.0, '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': 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': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '0.74', 'valuenum': 0.74, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, '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': '8.8', 'valuenum': 8.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81.7', 'valuenum': 81.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.77', 'valuenum': 0.77, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.15', 'valuenum': 7.15, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.3', 'valuenum': 47.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.66', 'valuenum': 4.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.2', '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 185.0, 'valueuom': 'mg/dL', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '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': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, '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': '4.49', 'valuenum': 4.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.4', 'valuenum': 46.4, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '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': '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', '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': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, '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': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.7', 'valuenum': 46.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, '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': '4.90', 'valuenum': 4.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '86', 'valuenum': 86.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, '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': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, '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': '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': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Upon discharge: \nAAO x 3, A&Ox3, Delt/traps ___, bic/tri ___, IPs 4+, ham 4\nIncision CDI, closed with staples.', 'diagnoses': [{'icd_code': 'S2220XA', 'desc': 'Unspecified fracture of sternum, initial encounter for closed fracture'}, {'icd_code': 'S27892A', 'desc': 'Contusion of other specified intrathoracic organs, initial encounter'}, {'icd_code': 'I9589', 'desc': 'Other hypotension'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'S01312A', 'desc': 'Laceration without foreign body of left ear, initial encounter'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'V4352XA', 'desc': 'Car driver injured in collision with other type car in traffic accident, initial encounter'}, {'icd_code': 'Y92411', 'desc': 'Interstate highway as the place of occurrence of the external cause'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z923', 'desc': 'Personal history of irradiation'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}], 'summary': "___ CXR\nNo change in appearance as compared to ___. Left \npectoral pacemaker in situ. Pacemaker leads in correct \nposition. Moderate cardiomegaly. Tortuosity of the descending \naorta. Minimal scarring at the bases of the left lower lobe. \nNo pneumonia, no pulmonary edema, no pleural effusions. \n\n___ AP & lateral spine xrays\nThe provided fluoroscopic spot images demonstrate posterior \nfusion of the \nocciput through the C6 level. There is no hardware complication. \nThere is \nanterior subluxation of C3 on C4, not significantly changed \ncompared to the MRI from ___. Multiple wires project \nover the cervical region and calvaria. For additional details, \nplease see the operative report in the ___ medical \nrecord. \n\n___ 05:50AM BLOOD WBC-6.0 RBC-2.99* Hgb-9.7* Hct-28.5* \nMCV-95 MCH-32.4* MCHC-34.0 RDW-14.9 Plt ___\n___ 05:50AM BLOOD ___ PTT-24.8* ___\n___ 05:50AM BLOOD Glucose-84 UreaN-32* Creat-1.4* Na-140 \nK-3.9 Cl-101 HCO3-28 AnGap-15\n___ 01:28AM BLOOD Glucose-130* UreaN-34* Creat-1.6* Na-140 \nK-3.9 Cl-102 HCO3-24 AnGap-18\n___ 03:35PM BLOOD Glucose-113* UreaN-34* Creat-1.5* Na-136 \nK-4.2 Cl-104 HCO3-24 AnGap-12\n___ 05:30AM BLOOD Glucose-82 UreaN-39* Creat-1.8* Na-139 \nK-4.0 Cl-104 HCO3-26 AnGap-13\n___ 06:30AM BLOOD Glucose-79 UreaN-44* Creat-2.1* Na-142 \nK-4.1 Cl-104 HCO3-26 AnGap-16\n___ 05:50AM BLOOD Calcium-8.7 Phos-4.2 Mg-1.9\n___ 01:28AM BLOOD Calcium-8.9 Phos-4.7* Mg-2.1\n___ 03:35PM BLOOD Calcium-9.0 Phos-3.7 Mg-1.6\n___ 05:30AM BLOOD Calcium-9.0 Phos-3.4 Mg-2.1\n___ 06:30AM BLOOD Calcium-8.6 Phos-3.7 Mg-1.7\nOn ___ Patient was directed admitted to the neurosurgical \nservice for planned surgery. \n\nOn ___ Patient remained neurologically stable. Blood pressure \nmedications were held for low pressure. He was fluid repleted. \n\nOn ___ Patient was taken to OR for Occiput to C6 Fusion. Patient \ninitially lost BP on flipping onto OR table. Unclear cause but \nself resolved. Uncomplicated fusion, intra-op films looked good. \nPost operatively patient was transferred to ICU overnight for \nmonitoring. \n\nOn ___ Patient remained stable, cervical collar in place. He was \ntransferred to floor in stable condition. \n\nOn ___, the patient's surgical drain was removed. Due to \ndifficulty in properly fitting his hard collar, he was \ntransitioned to a soft collar, which he was instructed to wear \nat all times. Physical Therapy was consulted for evaluation.\n\nOn the afternoon of ___, Mr. ___ was discharged to a SNF. \nWe have recommended that the patient not resume his Eloquis (for \natrial fibrillation) due to risk of hemorrhage or bleeding. \n\nAt the time of discharge, Mr. ___ was afebrile, \nhemodynamically and neurologically intact."}}
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{'final_diagnoses': ['C2 lytic lesion'], 'procedures': ['___ Occiput to C6 Fusion'], 'visit_summary': "On ___ Patient was directed admitted to the neurosurgical \nservice for planned surgery. \n\nOn ___ Patient remained neurologically stable. Blood pressure \nmedications were held for low pressure. He was fluid repleted. \n\nOn ___ Patient was taken to OR for Occiput to C6 Fusion. Patient \ninitially lost BP on flipping onto OR table. Unclear cause but \nself resolved. Uncomplicated fusion, intra-op films looked good. \nPost operatively patient was transferred to ICU overnight for \nmonitoring. \n\nOn ___ Patient remained stable, cervical collar in place. He was \ntransferred to floor in stable condition. \n\nOn ___, the patient's surgical drain was removed. Due to \ndifficulty in properly fitting his hard collar, he was \ntransitioned to a soft collar, which he was instructed to wear \nat all times. Physical Therapy was consulted for evaluation.\n\nOn the afternoon of ___, Mr. ___ was discharged to a SNF. \nWe have recommended that the patient not resume his Eloquis (for \natrial fibrillation) due to risk of hemorrhage or bleeding. \n\nAt the time of discharge, Mr. ___ was afebrile, \nhemodynamically and neurologically intact.", 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN fever/pain', '2. Amiodarone 200 mg PO DAILY', '3. Bisacodyl 10 mg PR QHS:PRN Constipation', '4. Carvedilol 12.5 mg PO BID', '5. Docusate Sodium 100 mg PO BID', '6. Finasteride 5 mg PO DAILY', '7. Fleet Enema ___AILY:PRN constipation', '8. Furosemide 40 mg PO DAILY', '9. Levothyroxine Sodium 25 mcg PO DAILY', '10. Lisinopril 10 mg PO DAILY', '11. melatonin 5 mg oral QPM', '12. Milk of Magnesia 30 mL PO DAILY:PRN Constipation', '13. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*45 Tablet Refills:*0', '14. Senna 8.6 mg PO BID:PRN constipation', '15. Colchicine 0.6 mg PO DAILY', '16. Famotidine 20 mg PO DAILY', '17. Multivitamins 1 TAB PO DAILY', '18. Mirtazapine 7.5 mg PO EVERY OTHER HS']}
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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': 'Nausea, vomiting, abdominal pain', 'medical_history': ['hepatitis C', 'IDDM', 'gastroparesis', 'peripheral neuropathy', 'glaucoma', 'seizures', 'Right knee surgery'], 'family_history': 'NC', 'present_illness': '___ y/o male s/p pancreas transplant ___ who presents with \nc/o nausea, vomiting and abdominal pain c/w gastroparesis \nexacerbations. Blood sugars are consistently less than 140 and \nhe has no other constitutional symptoms. He initially presented \nto OSH and was transferred to ___ for further evaluation.', 'medications': [{'medication': 'Doxycycline Hyclate', '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': 'ASDIR', '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': 'OxyCODONE (Immediate Release)', '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', 'route': 'IV', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued 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', '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': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim SS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Clobetasol Propionate 0.05% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', '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}]}, 'clinical_findings': {'labs': [{'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': '0.3', 'valuenum': 0.3, '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': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, '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': '238', 'valuenum': 238.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.14', 'valuenum': 0.14, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.04', 'valuenum': 9.04, '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': '51.0', 'valuenum': 51.0, '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': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.6, '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 1.4, . estimated GFR (eGFR) is likely between 49 and 59 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': 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': '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': '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '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': '1.7', 'valuenum': 1.7, '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': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 34.0, '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': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '267', 'valuenum': 267.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.6', 'valuenum': 50.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '520', 'valuenum': 520.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, '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': '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': '30', 'valuenum': 30.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 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'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': '33.2', 'valuenum': 33.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': 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'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '50.5', 'valuenum': 50.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '266', 'valuenum': 266.0, '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': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 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'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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 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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', 'valuenum': 2.0, '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.235', 'valuenum': 0.235, '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': '1.89', 'valuenum': 1.89, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.033', 'valuenum': 0.033, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: 98.2, 92, 142/94, 18, 98%RA\nGen: A+Ox3, NAD, multiple tattoos, vomiting has resolved\nCard: Reg rhythm, tachy,\nAbd: Soft, distended and tender but no abdominal pain\nExtr: MAE, ___ bilateral lower extremities', 'diagnoses': [{'icd_code': 'L120', 'desc': 'Bullous pemphigoid'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z96642', 'desc': 'Presence of left artificial hip joint'}, {'icd_code': 'D72828', 'desc': 'Other elevated white blood cell count'}, {'icd_code': 'T380X5A', 'desc': 'Adverse effect of glucocorticoids and synthetic analogues, initial encounter'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'D638', 'desc': 'Anemia in other chronic diseases classified elsewhere'}, {'icd_code': 'T45516A', 'desc': 'Underdosing of anticoagulants, initial encounter'}, {'icd_code': 'Z91128', 'desc': "Patient's intentional underdosing of medication regimen for other reason"}, {'icd_code': 'J384', 'desc': 'Edema of larynx'}, {'icd_code': 'J392', 'desc': 'Other diseases of pharynx'}], 'summary': 'On Admission: ___\nWBC-5.0 RBC-2.88* Hgb-9.3* Hct-27.9* MCV-97 MCH-32.4* MCHC-33.4 \nRDW-16.9* Plt ___ PTT-26.1 ___\nGlucose-109* UreaN-17 Creat-0.7 Na-140 K-4.4 Cl-107 HCO3-25 \nAnGap-12\nALT-7 AST-12 AlkPhos-63 TotBili-0.3 Lipase-19\nCalcium-8.4 Phos-4.1 Mg-1.5*\nAt Discharge: \nWBC-2.0*# RBC-3.05* Hgb-9.7* Hct-29.5* MCV-97 MCH-31.7 MCHC-32.8 \nRDW-16.5* Plt ___\nGlucose-83 UreaN-11 Creat-0.9 Na-140 K-4.0 Cl-104 HCO3-28 \nAnGap-12\nAmylase-45 Lipase-19\nCalcium-8.9 Phos-5.2* Mg-1.5*\ntacroFK-10.___ y/o male who was admitted with recurring gastroparesis \nsymptoms, 2 months s/p pancreas transplant.\nThe patient was made NPO, hydrated and given IV reglan.\nHis abdomen remained soft, non-distended with + bowel sounds. \nHis nausea subsided and his diet was advanced to regular with \ngood tolerance although he did have sompaints intermittently of \nabdominal pain.\nHe was scheduled to see Dr ___ GI ___ this ___, \nhowever he came by to see patient while in house. His \nrecommendations include dropping his Reglan to TID as tolerated, \nand returning to QID if needed. Per his note it appears he is \ntrying to wean patient down on the Reglan. He will continue to \nfollow with Dr ___ as an outpatient.'}}
|
{'final_diagnoses': ['s/p pancreas transplant 2 months ago', 'gastroparesis exacerbation'], 'procedures': ['None'], 'visit_summary': 'tacroFK-10.___ y/o male who was admitted with recurring gastroparesis \nsymptoms, 2 months s/p pancreas transplant.\nThe patient was made NPO, hydrated and given IV reglan.\nHis abdomen remained soft, non-distended with + bowel sounds. \nHis nausea subsided and his diet was advanced to regular with \ngood tolerance although he did have sompaints intermittently of \nabdominal pain.\nHe was scheduled to see Dr ___ GI ___ this ___, \nhowever he came by to see patient while in house. His \nrecommendations include dropping his Reglan to TID as tolerated, \nand returning to QID if needed. Per his note it appears he is \ntrying to wean patient down on the Reglan. He will continue to \nfollow with Dr ___ as an outpatient.', 'medications_prescribed': ['Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) \nTablet PO DAILY (Daily).', 'Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Dronabinol 2.5 mg Capsule Sig: Four (4) Capsule PO TID (3 \ntimes a day).', 'Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Three \n(3) Capsule, Delayed Release(E.C.) PO DAILY (Daily).', 'Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every \n8 hours).', 'Topiramate 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO \nQID (4 times a day).', 'Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO twice a day.', 'Tacrolimus 5 mg Capsule Sig: One (1) Capsule PO twice a day.', 'Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO twice a day.', 'Reglan 10 mg Tablet Sig: Two (2) Tablet PO four times a day.', 'Fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr \nTransdermal Q72H (every 72 hours).', 'Diazepam 10 mg Tablet Sig: One (1) Tablet PO four times a \nday.']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 88, 'gender': 'M', 'symptoms': 'transfer of care for NICU proximity', 'medical_history': ['OBHx: G5P3', '- SVD x3, FT x 2, ___ x 1', '- SAB x 2, D&C x 1', '- GDMA1 in most recent pregnancy, diet controlled', 'PGYNHx:', '- Denies hx of ectopic pregnancy, fibroids, endometriosis. \nRemote\nhistory of chlamydia s/p treatment.', '- Denies hx of abnormal pap smears.', 'PMHx: Denies', 'PSHx:', '- D&C for SAB'], 'family_history': 'NC', 'present_illness': 'Ms. ___ is a ___ yo G5 now ___ s/p SVD at ___ on ___ at 35 weeks transferred to ___ for NICU proximity.\nPatient went into preterm labor ___ with subsequent\nuncomplicated SVD on ___. This pregnancy was complicated by\nGDMA1, diet controlled. She reports her pain is well controlled\nwith Ibuprofen, bleeding is minimal, breast feeding is going\nwell, and denies CP, SOB.', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', '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': 'Phentolamine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', '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': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '6.2', 'valuenum': 6.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, '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': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91.2', 'valuenum': 91.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '245', 'valuenum': 245.0, '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': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, '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': "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': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.5', 'valuenum': 3.5, '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': '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': 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': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, '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': 'MOD.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-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': '73', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg. HEMOLYZED, MODERATELY.'}, {'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': '___', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K. HEMOLYZED, MODERATELY.'}, {'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': '24', 'valuenum': 24.0, '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': '___', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYZED, MODERATELY.'}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, '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': '31.4', 'valuenum': 31.4, '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': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96.8', 'valuenum': 96.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '251', 'valuenum': 251.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.59', 'valuenum': 4.59, '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}], 'exams': 'Gen: NAD, well-appearing\nBreasts: non-tender, no erythema\nCV: RRR\nResp: no respiratory distress \nAbd: soft, non-tender, fundus firm 3 cm below umbilicus \nGU: scant spotting \nExt: non-tender, no edema', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '1623', 'desc': 'Malignant neoplasm of upper lobe, bronchus or lung'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '7994', 'desc': 'Cachexia'}, {'icd_code': '25541', 'desc': 'Glucocorticoid deficiency'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': 'V851'}], 'summary': '___ 12:00AM HCT-36\n___ yo ___ s/p SVD at ___ Hospital on ___ at 35 weeks \ntransferred to ___ for NICU proximity. She remained stable \nwithout issues. She was discharged in stable condition on \n___ with plan for repeat glucose screening at 6 week \npostpartum visit for GDMA1.'}}
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{'final_diagnoses': ['postpartum (preterm birth at ___ hospital, transferred to \n___ for postpartum care to be near baby in NICU)'], 'procedures': ['none'], 'visit_summary': '___ yo ___ s/p SVD at ___ Hospital on ___ at 35 weeks \ntransferred to ___ for NICU proximity. She remained stable \nwithout issues. She was discharged in stable condition on \n___ with plan for repeat glucose screening at 6 week \npostpartum visit for GDMA1.', 'medications_prescribed': ['PNV']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 62, 'gender': 'M', 'symptoms': 'weakness, diarrhea', 'medical_history': ['down syndrome', 'alzheimers', 'C1-C2 ligament abnormality, bilateral hand numbness', 'history of cervical and lumbar spine surgeries', 'gout', 'hyperlipidemia', 'colonic adenoma polyp'], 'family_history': '- Mother: lung cancer\n- Father: bladder cancer, dementia\n- Sister: breast cancer', 'present_illness': " Mr. ___ is a ___ yoM w/down syndrome, alzheimers, \nabnormal C1-C2 interspinous ligament followed by neurosurgery \nresulting in bilateral hand numbness, history of cervical and \nlumbar spine surgeries, and history of duodenal ulcer several \nyears ago r/t NSAID use, who initially presented to ___ \n___ w/subacute progressive diarrhea and weakness, now \ntransferred to ___ w/upper GI bleed. \n Per OSH record, patient has had progressive weakness over past \nseveral months, particularly in his bilateral hands with \nincrease in dropping things. He has also had worsening gait \ninstability. He underwent neurosurgical evaluation, MRI and was \nfound to have enhancement of interspinous ligament between C1 \nand C2. According to patient's family, no surgical intervention \nhas been planned. In addition to weakness, patient's family has \nnoticed worsening in patient's reflux symptoms over the past \nmonth, occurring after meals. Of note patient has history of \nduodenal ulcer ___ NSAID use and has reportedly has used NSAIDS \nfor pain w/ambulation in past several weeks. Patient developed \ndiarrhea ~1 week prior to presentation, ___ episodes daily, no \nblood or melena. No fevers, chills, chest pain, SOB, nausea, \nvomiting or dysuria. \n Patient was initially admitted for workup of possible UTI (UA \nw/nitritres, bacteria) in addition to worsening weakness and \ndiarrhea. On ___ patient had episode of hematemesis, so was \nintubated and brought for urgent EGD. At that time patient's HCT \nhad dropped from 37.4 to 30.6. EGD revealed duodenal ulcer with \nexposed vessel which was subsequently clipped. They also \nadministered epi to the ulcer. Patient was extubated and \nsubsequently experienced hypercarbic/hypoxemic respiratory \nfailure requiring NIPPV. This was thought to be ___ anesthesia \nand undelying OSA. CXR showed RLL consolidation concerning for \natelectasis vs aspiration. Patient's oxygenation improved \novernight and Hb remained stable. On morning of ___, patient \nhad two large melenic BM's, became hypotensive requiring IVF and \nlevophed and HCT had dropped to 20.3. He was electively \nintubated and underwent second EGD and duodenal ulcer was found \nto be bleeding, so they again administered epi but there was no \nvessel to clip. Lactate, renal function all remained wnl. \nPatient received an additional unit of PRBC's post procedure in \naddition to bag of platelets and was transferred to ___ for \nconsideration of ___ procedure. \n \n On arrival to MICU vitals were: afebrile, HR in 40-50's sinus, \nBP 110's/50's on 0.3 Levophed. Patient had small melenic stool \non arrival. He was intubated and sedated and unable to provide \nhistory.", 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Terazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', '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': 'PO', '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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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 (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 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': 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': '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': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': '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': 'MetRONIDAZOLE (FLagyl)', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Doxazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 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9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 24.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.54', 'valuenum': 7.54, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, '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': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '159', 'valuenum': 159.0, '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': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 227.0, 'valueuom': 'mg/dL', '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, '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': '34.4', 'valuenum': 34.4, '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': '172', 'valuenum': 172.0, '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': '4.04', 'valuenum': 4.04, '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': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '======================\nADMISSION TO MEDICINE:\n======================\nVital Signs: T 99.1 BP 116/49 HR 63 RR 17 O2 96% on 2L NC \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclerae anicteric, MMM, oropharynx clear, neck supple, \nJVP 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, tender to deep palpation over RUQ, non-distended, \nbowel sounds present, no rebound tenderness or guarding, no \norganomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSkin: Without rashes or lesions \nNeuro: CN II-XII intact, bilateral strength ___, DTR 2+ \nbilaterally\n\n==========\nDISCHARGE:\n==========\nVitals: T 98.3 BP 99/65 HR 56 RR 18 O2 92% on RA\nWeight: 206.79 lbs (___\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclerae anicteric, MMM\nLungs: Clear to auscultation anteriorly, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 + S2, ___ blowing \nholosystolic murmur most prominent at RUSB, no rubs or gallops\nAbdomen: Normoactive bowel sounds present, soft, non-distended, \nnon-tender, no rebound tenderness or guarding\nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema in lower extremities; R hallux extended. RUE with minimal \nswelling, improved from ___. No longer tender to palpation, \nwith resolution of dependent edema. Radial pulse on R intact, \ngood cap refill. Sensation intact to light touch in RUE.\nSkin: Without rashes or lesions. \nMSK: Shoulders non-erythematous, non-swollen. R shoulder tender \nto deep palpation. Passive ROM intact.\nNeuro: moves all four extremities spontaneously.', 'diagnoses': [{'icd_code': '03849', 'desc': 'Other septicemia due to gram-negative organisms'}, {'icd_code': '5770', 'desc': 'Acute pancreatitis'}, {'icd_code': '29181', 'desc': 'Alcohol withdrawal'}, {'icd_code': '5119', 'desc': 'Unspecified pleural effusion'}, {'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}], 'summary': "==========================\nADMISSION/SIGNIFICANT LABS:\n==========================\n___ 06:15PM BLOOD WBC-11.3*# RBC-2.83*# Hgb-8.9*# \nHct-25.6*# MCV-91# MCH-31.4 MCHC-34.8 RDW-14.7 RDWSD-48.4* Plt \n___\n___ 06:15PM BLOOD Neuts-73.2* Lymphs-12.8* Monos-12.4 \nEos-0.3* Baso-0.6 NRBC-0.3* Im ___ AbsNeut-8.24*# \nAbsLymp-1.44 AbsMono-1.40* AbsEos-0.03* AbsBaso-0.07\n___ 06:15PM BLOOD Glucose-139* UreaN-23* Creat-0.6 Na-137 \nK-4.2 Cl-107 HCO3-24 AnGap-10\n___ 06:15PM BLOOD Calcium-7.0* Phos-1.8* Mg-1.6\n___ 06:15PM BLOOD Type-ART pO2-345* pCO2-36 pH-7.45 \ncalTCO2-26 Base XS-2\n___ 06:15PM BLOOD Lactate-1.3\n\nMICRO:\n=====\nOSH Micro: \nUrine culture ___: No growth (final)\nStool cultures ___: Negative (final)\nBlood culture ___: NGTD\n\nSerology/Blood ___: H. Pylori Antibody NEGATIVE\nUrine culture ___: Enterococcus Sp.. >100,000 CFU/ml\nBlood culture ___:\nUrine culture ___: Enterococcus Sp.. >100,000 CFU/ml and \nPseudomonas Aeruginosa 10,000-100,000 CFU/ml\n\n======================\nIMAGING/OTHER STUDIES:\n======================\nImages:\nCXR ___ OSH\nINDICATION: ETT PLACEMENT ETT PLACEMENT\nIMPRESSION: ET tube tip is 5 cm above the carina. Right PICC \nline\ntip is at the level of lower SVC. Heart size and mediastinum \nare\nunchanged including mild cardiomegaly.There is new right lower \nlobe opacity highly concerning for interval development of \naspiration.\n\nCXR ___\nIMPRESSION:\nIn comparison to ___ radiograph, mild cardiomegaly \nis accompanied by worsening pulmonary vascular congestion and \nmild edema. Left retrocardiac opacity has slightly improved. \nSmall pleural effusions are persistent findings. \n\nCXR ___\nIMPRESSION:\n No significant interval change since the prior examination. \n\nEXT VEINS ULTRASOUND ___\nIMPRESSION:\n1. Occlusive thrombosis involving the right axillary, one right \nbrachial, and right basilic veins. \n2. PICC courses through the right axillary and right basilic \nveins. \n\n===================\nProcedures/Studies:\n===================\n\nEndoscopy Report ___\nIMPRESSION:\nActive bleeding from duodenal ulcer successfully treated with \nepinephrine injection and placement of MRI conditional hemoclip. \n There was no bleeding at the end of the procedure. Gastritis. \nNormal\nesophagus.\n\nEndoscopy Report ___\nIMPRESSION AND PLAN:\nA large actively bleeding vessel in the area previously \nidentified as\nthe duodenal sweep with a large ulcer bed on his endoscopy 2 \ndays ago.\nThis ulcer and actively bleeding vessel are in the region of the\ngastroduodenal artery. His bleeding has temporarily been \nstopped with\nepinephrine injection, however, the vessel is too large to \nintervene\nendoscopically, and assistance from Interventional Radiology and \nSurgery are not available at this time, therefore, a decision \nwas made to transfer him to ___ in ___ and \ncommunications have been made with the physicians\n\n___ ___ ___\nIMPRESSION:\nSuccessful coil and Gel-Foam embolization of the gastroduodenal \nartery to \nstasis. \n\nEKG: Sinus bradycardia rate 49, no ischemic changes. QTc 401.\n\n==================\nLABS AT DISCHARGE:\n==================\n___ 05:31AM BLOOD WBC-4.9 RBC-2.63* Hgb-8.0* Hct-25.7* \nMCV-98 MCH-30.4 MCHC-31.1* RDW-13.9 RDWSD-48.0* Plt ___\n___ 05:31AM BLOOD ___ PTT-75.7* ___\nwith PMHx duodenal ulcers (reportedly ___ NSAIDs), Down \nsyndrome (with C1-C2 instability followed by NSGY), and \nAlzheimer's disease who presented to ___ with diarrhea \nand hand weakness, transferred to ___ for hematemesis and \nmanagement of upper GI bleed. Pt required an ICU stay at \n___ for his hemodynamic instability, requiring pressors and \nmultiple blood transfusions. He had two EGD's with epinephrine \nand clipping attempts, which were ultimately unsuccessful. Pt \nwas transferred to ___ for ___ coiling of the GDA on ___, \nwhich resolved his GI bleeding. He was initiated on BID PPI and \nsucralfate. Course complicated by RUE DVT associated with PICC \nline, which required heparin to warfarin bridge. Pt's CBC was \nstable, and INR therapeutic x48hrs, at time of discharge. He was \ntreated with a 5 day course of amoxicillin for an Enterococcus \nUTI (to be completed ___."}}
|
{'final_diagnoses': ['Duodenal ulcer, status post gastroduodenal artery coiling', 'Acute blood loss anemia', 'deep vein thrombosis, PICC-associated', 'Down Syndrome', "History of Alzheimer's disease", 'C1-C2 instability', 'Gout', 'Hyperlipidemia', 'BPH'], 'procedures': ['Gastroduodenal artery coiling (___)', 'Intubation and extubation'], 'visit_summary': "with PMHx duodenal ulcers (reportedly ___ NSAIDs), Down \nsyndrome (with C1-C2 instability followed by NSGY), and \nAlzheimer's disease who presented to ___ with diarrhea \nand hand weakness, transferred to ___ for hematemesis and \nmanagement of upper GI bleed. Pt required an ICU stay at \n___ for his hemodynamic instability, requiring pressors and \nmultiple blood transfusions. He had two EGD's with epinephrine \nand clipping attempts, which were ultimately unsuccessful. Pt \nwas transferred to ___ for ___ coiling of the GDA on ___, \nwhich resolved his GI bleeding. He was initiated on BID PPI and \nsucralfate. Course complicated by RUE DVT associated with PICC \nline, which required heparin to warfarin bridge. Pt's CBC was \nstable, and INR therapeutic x48hrs, at time of discharge. He was \ntreated with a 5 day course of amoxicillin for an Enterococcus \nUTI (to be completed ___.", 'medications_prescribed': ['Amoxicillin 500 mg PO Q8H Duration: 5 Days \nStart date: ___\nEnd date: ___ \nRX *amoxicillin 500 mg 1 tablet(s) by mouth three times a day \nDisp #*5 Tablet Refills:*0', 'Pantoprazole 40 mg PO Q12H \nRX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp \n#*60 Tablet Refills:*0', 'Sucralfate 1 gm PO QID \nRX *sucralfate 1 gram/10 mL 10 mL by mouth four times a day \nRefills:*0', 'Tamsulosin 0.4 mg PO QHS \nRX *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime Disp #*30 \nCapsule Refills:*0', 'Warfarin 2.5 mg PO DAILY16 \nRX *warfarin 2.5 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet \nRefills:*0', 'Allopurinol ___ mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Donepezil 5 mg PO QHS']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 34, 'gender': 'M', 'symptoms': 'Chest pain', 'medical_history': ['Cardiac Risk Factors: +Diabetes, +Dyslipidemia, Hypertension', 'No hx of CABG, pacemaker/ICD. Per pt, PCI ___ yrs ago was nl', '-Carotid stenois, no hx intervention', '-macular degeneration', '-vertigo', '-s/p ccy, appy'], 'family_history': 'mother with COPD, macular degeneration, father with MI', 'present_illness': 'Mrs ___ is a pleasant ___ yo female with hx diet \ncontrolled DM diabetes, who was visiting her husband in the \ntrauma ICU today for a family meeting when when she developed CP \nand SOB. She and her husband recently traveled to ___ from home \nin ___, when her husband attempted suicide. Pt states that she \nhas been having CP and SOB with episodes of anxiety related to \nthis event, however denies hx of CP. She discribes the pain as \nL-sided and non-radiating. She has had SOB with exertion in the \npast for which she has been seeing a cardiologist, with cath ___ \nyrs ago which was nl and was done after abnormal stress test, \nper pt report. Her CP has since resolved since the episode \nearlier today. \n. \nIn the ED, pt was given aspirin and SLNTG. First set of cardiac \nenzymes was negative. \n. \nOn the floor, pt is CP free and asymptomatic, comfortable, \nperseverating on husbands health and recent suicide attempt. \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, joint pains, cough, hemoptysis, black \nstools or red stools. She denies recent fevers, chills or \nrigors. She denies exertional buttock or calf pain. She states \nthat she feels sad, but denies SI/HI. Pt c/o R "scapular" pain, \nwhich is chronic and not present currently. \n. \n*** Cardiac review of systems is notable for absence of \nparoxysmal nocturnal dyspnea, orthopnea, ankle edema, \npalpitations, syncope or presyncope.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 625.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 84.0, '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, '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': '28.6', 'valuenum': 28.6, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.34', 'valuenum': 4.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 655.0, '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': '24', 'valuenum': 24.0, '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': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 622.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '143', 'valuenum': 143.0, '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': '2', 'valuenum': 2.0, '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': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '43.0', 'valuenum': 43.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS - 97.2 136/67 85 18 97% RA \nGen: WDWN pleasant elderly woman in NAD. Oriented x3. Mood, \naffect appropriate given circumastances. \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. \nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \n\nChest: pectus excavatum, scoliosis or kyphosis. Resp were \nunlabored, no accessory muscle use. CTAB, mild crackles in R \nbase, wheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. \nExt: No c/c/e. No femoral bruits. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.', 'diagnoses': [{'icd_code': 'S80812A', 'desc': 'Abrasion, left lower leg, initial encounter'}, {'icd_code': 'S80811A', 'desc': 'Abrasion, right lower leg, initial encounter'}, {'icd_code': 'S80211A', 'desc': 'Abrasion, right knee, initial encounter'}, {'icd_code': 'W200XXA', 'desc': 'Struck by falling object in cave-in, initial encounter'}, {'icd_code': 'Y9269', 'desc': 'Other specified industrial and construction area as the place of occurrence of the external cause'}], 'summary': '___ 06:19AM cTropnT-<0.01\n___ 10:20PM cTropnT-<0.01\n___ 10:20PM CK-MB-2\n___ 04:14PM cTropnT-<0.01\n___ 04:14PM calTIBC-309 FERRITIN-209* TRF-238\n___ 04:14PM WBC-6.4 RBC-3.92* HGB-11.9* HCT-35.4* MCV-90 \nMCH-30.5 MCHC-33.7 RDW-13.9\n___ 04:14PM GLUCOSE-125* UREA N-24* CREAT-0.9 SODIUM-139 \nPOTASSIUM-4.1 CHLORIDE-106 TOTAL CO2-23 ANION GAP-14\n\nCXR ___: 1. Left hemidiaphragm not well seen laterally, which \nmay relate to overlying soft tissue, although a trace effusion \nor mild left base atelectasis cannot be excluded. Consider \ndedicated PA and lateral views for better evaluation. 2. Mild \ncardiomegaly without overt pulmonary edema.\nMs. ___ is a pleasant ___ yo female admitted for chest \npain in the setting of emotional distress. Her hospital course \nby problem is as follows:\n. \n#. Chest pain: Patient with RFs for ACS (dyslipidemia and DM), \nhowever CP somewhat atypical. Cardiac markers were sent and were \nnegative x3. EKG findings were non-specific and consistent with \nher prior EKG in ___ obtained from her outpatient cardiologist. \nHer morning EKG showed no dynamic changes from prior as well. \nPatient does report history of exertional SOB and has history of \npositive stress tests and a negative cath ___ years ago (which \nshowed an isolated LM lesion of 50%). Given her increased level \nof stress in the setting of husband\'s recent suicide attempt and \npatient\'s history of similar pain in the setting of extreme \nstress/tragedy, this episode of chest pain seemed consistent \nwith anxiety related pain and was not alarming for ACS or a new \nflow limiting lesion. Patient was given asa daily and monitored \non telemetry. She did not experience any further episodes of \nchest pain during her hospitalization. On discharge she was \ngiven a prescription for ativan and instructions to use if \nshould she experience anxiety (and avoid drinking, driving, and \noperating heavy machinery while taking the medication). We \nrecommended that she follow up with her outpatient cardiologist \nwhen she returns to ___. \n\n#. Diabetes mellitus: Patient has DM which is diet controlled. \nShe was given a diabetic heart healthy diet while hospitalized \nand finger stick blood sugars were monitored. There were no \nacute issues during hospitalization. \n\n#. Anemia: Patient had a hct of 33.6, which turned out to be \nfairly consistent with her baseline based on her outpatient \ncardiology records. FE panel sent was not consistent with iron \ndeficiency anemia. Patient would benefit from an outpatient work \nup of her anemia. She remained hemodynamically stable during \nhospitalization with no evidence of active bleed. Folate and B12 \nlevels were pending at the time of discharge. \n \n#. Psychosocial: Pt was struggling to cope with her husband\'s \nrecent suicide attempt, saying, "I never saw it coming. I don\'t \nknow what I missed." She maintained positive temperament despite \neverything and denied any SI. "I love life, I have a lot to live \nfor." She was seen by social work and we encouraged her to seek \ncounseling with a psychologist in the future should that be \nhelpful to her.\n- pending social work consult \n. \n#. The patient\'s other medical problems including dyslipidemia \nand macular degeneration were managed without acute events. She \nwas DNR/DNI during this admission.'}}
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{'final_diagnoses': ['Chest pain', 'Dyslipidemia', 'Diabetes Mellitus', 'Borderline HTN', 'Carotid stenosis', 'Vertigo'], 'procedures': ['None.'], 'visit_summary': 'Ms. ___ is a pleasant ___ yo female admitted for chest \npain in the setting of emotional distress. Her hospital course \nby problem is as follows:\n. \n#. Chest pain: Patient with RFs for ACS (dyslipidemia and DM), \nhowever CP somewhat atypical. Cardiac markers were sent and were \nnegative x3. EKG findings were non-specific and consistent with \nher prior EKG in ___ obtained from her outpatient cardiologist. \nHer morning EKG showed no dynamic changes from prior as well. \nPatient does report history of exertional SOB and has history of \npositive stress tests and a negative cath ___ years ago (which \nshowed an isolated LM lesion of 50%). Given her increased level \nof stress in the setting of husband\'s recent suicide attempt and \npatient\'s history of similar pain in the setting of extreme \nstress/tragedy, this episode of chest pain seemed consistent \nwith anxiety related pain and was not alarming for ACS or a new \nflow limiting lesion. Patient was given asa daily and monitored \non telemetry. She did not experience any further episodes of \nchest pain during her hospitalization. On discharge she was \ngiven a prescription for ativan and instructions to use if \nshould she experience anxiety (and avoid drinking, driving, and \noperating heavy machinery while taking the medication). We \nrecommended that she follow up with her outpatient cardiologist \nwhen she returns to ___. \n\n#. Diabetes mellitus: Patient has DM which is diet controlled. \nShe was given a diabetic heart healthy diet while hospitalized \nand finger stick blood sugars were monitored. There were no \nacute issues during hospitalization. \n\n#. Anemia: Patient had a hct of 33.6, which turned out to be \nfairly consistent with her baseline based on her outpatient \ncardiology records. FE panel sent was not consistent with iron \ndeficiency anemia. Patient would benefit from an outpatient work \nup of her anemia. She remained hemodynamically stable during \nhospitalization with no evidence of active bleed. Folate and B12 \nlevels were pending at the time of discharge. \n \n#. Psychosocial: Pt was struggling to cope with her husband\'s \nrecent suicide attempt, saying, "I never saw it coming. I don\'t \nknow what I missed." She maintained positive temperament despite \neverything and denied any SI. "I love life, I have a lot to live \nfor." She was seen by social work and we encouraged her to seek \ncounseling with a psychologist in the future should that be \nhelpful to her.\n- pending social work consult \n. \n#. The patient\'s other medical problems including dyslipidemia \nand macular degeneration were managed without acute events. She \nwas DNR/DNI during this admission.', 'medications_prescribed': ['Aspirin 325 mg Tablet Sig: One (1) Tablet PO every other day.', 'Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO DAILY (Daily).', 'Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO QOD ().', 'Ativan 0.5 mg Tablet Sig: One (1) Tablet PO as needed for \nanxiety as needed for anxiety.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 19, 'gender': 'M', 'symptoms': 'lightheadedness', 'medical_history': ['HTN', 'HLD', 'thalassemia minor', 'breast reduction surgery'], 'family_history': 'Mother with heart attack at ___, father with\nstents placed in his ___', 'present_illness': '___ with stress echo positive with basilar inferior wall \nhypokinesis consistent with ischemia, presents with \nlightheadedness that began 1 wk ago. Lightheadedness occurs both \nwith exertion and at rest, nearly constant. Pt presented to her \nPCP at symptom onset, was told she is dehydrated. Also has 3 day \nh/o throbbing right upper back pain that was constant, now \nintermittent and worse with movement. Back pain ___ ___ with movement and improved with heating pad.\nEKG unremarkable, but given inducible ischemia on stress echo \nand atypical back pain, light headedness-decision was made to \nadmit given her atypical symptoms and known coronary disease. \nED vitals: T 97.8, HR 57, RR 16, BP 131/74, O2 sat 99 RA.\nReceived 1mg ativan in the ED. \nUpon transfer to the floor, pt denies any lightheadedness, chest \npain, SOB. Right upper back pain only with movement. ', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H: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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim SS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Viscous 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', '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': 'Q2H: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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H: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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pyridoxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'rifapentine', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QFRI', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H: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': '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Isoniazid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QFRI', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 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'Inactive (Due to a change order)', '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': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', '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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H: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': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Budesonide', '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': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change 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None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.014', 'valuenum': 1.014, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', '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': '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': '140', 'valuenum': 140.0, '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': '38.3', 'valuenum': 38.3, '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': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, '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': '4.26', 'valuenum': 4.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.4', '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': '___', 'valuenum': 112.0, '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': '6', 'valuenum': 6.0, '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': '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': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '249', 'valuenum': 249.0, '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': '4.51', 'valuenum': 4.51, '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.3', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, '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': '250', 'valuenum': 250.0, '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': '4.19', 'valuenum': 4.19, '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': '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '273', 'valuenum': 273.0, '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': '4.33', 'valuenum': 4.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, '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': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, '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': '29.3', 'valuenum': 29.3, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '245', 'valuenum': 245.0, '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': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '0.4', 'valuenum': 0.4, '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': '39.0', 'valuenum': 39.0, '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': '22.7', 'valuenum': 22.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, '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': '8.0', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.8', 'valuenum': 67.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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 20-29 is 116 (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': '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': '3.8', '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': '13', 'valuenum': 13.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, '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': '36.0', 'valuenum': 36.0, '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': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '12.5', 'valuenum': 12.5, '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': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.2', '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.26', 'valuenum': 4.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '237', 'valuenum': 237.0, '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': '4.42', 'valuenum': 4.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, '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': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, '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': '260', 'valuenum': 260.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION:\nVS: 98 134/69 62 20 100% RA\nGen: Resting in bed. Anxious.\nHEENT: NC/AT. PERRL. \nCV: RRR. Nl S1, S2. No m/r/g\nPulm: CTAB\nAbd: Soft, NT, ND. Nl BS\nGU: No Foley\nExt: wwp with no c/c/e. TTP over right upper back/shoulder. No \nttp over spinous processes.\nSkin: No rash\nNeuro: Responds to questions appropriately\nPsych: Anxious mood. Normal affect\n\nDISCHARGE:\nVS: 98.1 ___ 57-62 ___ 97% RA\nGen: Resting in bed. \nHEENT: NC/AT. PERRL. \nCV: RRR. Nl S1, S2. No m/r/g\nPulm: CTAB\nAbd: Soft, NT, ND. Nl BS\nGU: No Foley\nExt: wwp with no c/c/e. TTP over right upper back/shoulder. No \nttp over spinous processes.\nSkin: No rash\nNeuro: Responds to questions appropriately\nPsych: Normal mood. Normal affect', 'diagnoses': [{'icd_code': '5552', 'desc': 'Regional enteritis of small intestine with large intestine'}, {'icd_code': '5770', 'desc': 'Acute pancreatitis'}, {'icd_code': '5771', 'desc': 'Chronic pancreatitis'}, {'icd_code': '79551', 'desc': 'Nonspecific reaction to tuberculin skin test without active tuberculosis'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': 'E9352', 'desc': 'Other opiates and related narcotics causing adverse effects in therapeutic use'}], 'summary': 'ADMISSION:\n___ 12:10PM BLOOD WBC-6.4 RBC-5.83* Hgb-11.0* Hct-37.8 \nMCV-65* MCH-18.9* MCHC-29.2* RDW-15.7* Plt ___\n___ 12:10PM BLOOD Neuts-67.6 ___ Monos-4.2 Eos-2.3 \nBaso-0.8\n___ 12:10PM BLOOD Glucose-119* UreaN-12 Creat-0.9 Na-135 \nK-5.2* Cl-105 HCO3-24 AnGap-11\n___ 12:10PM BLOOD cTropnT-<0.01\n___ 07:25PM BLOOD cTropnT-<0.01\n___ 07:25PM BLOOD Calcium-9.1 Phos-3.6 Mg-2.1\n___ 04:24PM BLOOD K-4.0\n.\nDISCHARGE:\n___ 07:00AM BLOOD WBC-4.7 RBC-5.55* Hgb-10.6* Hct-35.7* \nMCV-64* MCH-19.1* MCHC-29.7* RDW-15.7* Plt ___\n___ 07:00AM BLOOD Glucose-100 UreaN-7 Creat-0.7 Na-141 \nK-4.2 Cl-106 HCO3-27 AnGap-12\n___ 07:00AM BLOOD cTropnT-<0.01\n___ 07:00AM BLOOD Calcium-9.0 Phos-3.6 Mg-2.2\n.\nCXR ___: No acute intrathoracic abnormalities identified. \n.\nEKG ___ rhythm. HR 61. Nl axis, nl intervals. No ST \nelevation or depression. No T wave inversion, no hypertrophy.\n.\nNo events on telemetry\n___ with stress echo positive with basilar inferior wall \nhypokinesis consistent with ischemia, presents with \nlightheadedness that began 1 wk ago.\n\n# lightheadedness: No syncopal events. Pt describes \nlightheadedness as nearly constant for the first several days, \nmaking arrhythmia less likely. ECHO ___ shows nl EF. Lytes \nnl, Hct nl. Etiology may be orthostasis ___ HCTZ. Discontinued \nHCTZ ___ with some improvement in symptoms. Orthostatic \nvitals showed no orthostasis on ___. Advised pt to follow \nup with PCP if lightheadedness persists despite discontinuation \nof HCTZ. \n\n# CAD: Stress echo ___ positive with basilar inferior wall \nhypokinesis consistent with ischemia. Continued home ASA, \natorvastatin, lisinopril. Held HCTZ as above. Pt not on beta \nblocker, but will defer to PCP/cardiology regarding this \ndecision.\n\n## Transitional issues:\n- discontinued ___ - pt should have BP checked in outpatient \nsetting in next ___ days, with adjustment of regimen PRN\n- positive cardiac stress test - pt has cardiology appt ___'}}
|
{'final_diagnoses': ['Lightheadedness, likely medication induced', 'hypertension', 'coronary artery disease'], 'procedures': ['none'], 'visit_summary': '___ with stress echo positive with basilar inferior wall \nhypokinesis consistent with ischemia, presents with \nlightheadedness that began 1 wk ago.\n\n# lightheadedness: No syncopal events. Pt describes \nlightheadedness as nearly constant for the first several days, \nmaking arrhythmia less likely. ECHO ___ shows nl EF. Lytes \nnl, Hct nl. Etiology may be orthostasis ___ HCTZ. Discontinued \nHCTZ ___ with some improvement in symptoms. Orthostatic \nvitals showed no orthostasis on ___. Advised pt to follow \nup with PCP if lightheadedness persists despite discontinuation \nof HCTZ. \n\n# CAD: Stress echo ___ positive with basilar inferior wall \nhypokinesis consistent with ischemia. Continued home ASA, \natorvastatin, lisinopril. Held HCTZ as above. Pt not on beta \nblocker, but will defer to PCP/cardiology regarding this \ndecision.\n\n## Transitional issues:\n- discontinued ___ - pt should have BP checked in outpatient \nsetting in next ___ days, with adjustment of regimen PRN\n- positive cardiac stress test - pt has cardiology appt ___', 'medications_prescribed': ['Aspirin 81 mg PO DAILY ', 'Atorvastatin 80 mg PO DAILY ', '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': 74, 'gender': 'M', 'symptoms': 'Open R tibia fracture, RLE infection', 'medical_history': ['Depression', "Alcohol abuse (Hasn't drank for over ___ years)"], 'family_history': 'Non contributory', 'present_illness': 'Mr. ___ is a ___ s/p motorcycle crash on ___, with \nresulting right open tib-fib fracture with severe soft tissue \ncompromise and significant mid-tibia bone loss. Up to this \npoint, he has been cared for by Drs. ___ and ___ \n(Plastics) at ___. He is s/p right tibia IMN on \n___, followed by free flap from his abdomen on ___. He \nthen underwent tibial bone graft on ___. Unfortunately, he \ndeveloped infection after this surgery and underwent graft \nremoval and I&D on ___. On ___, he underwent repeat \nI&D, abx cement spacer placement, and posterior local tissue\nrearrangement with STSG for closure. This was his most recent \nsurgery. \n\nHe was recently referred to Dr. ___ definitive management \nof his complex RLE injury with possible ___ spatial frame, \nbut he ended up in the ED for evaluation due to concern for \ninfection involving his right leg operative site. He has a \nsmall area along the anterior/lateral border of his free\nflap which has opened up with some draining fibrinous exudate. \nHe denies fevers/chills/systemic constitutional symptoms. He \nhas significant pain with ankle ROM, which he has had since his \nindex surgery. He was admitted to Ortho service for management.', 'medications': [{'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS: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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', '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': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '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': 239.0, 'valueuom': 'mg/dL', '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\nRight lower extremity:\n- Thigh with multiple scars anteriorly from prior STSG harvest\nsites, well healed without signs of infection\n- Leg with multiple scars from prior surgeries, free flap \nappears\nhealthy with exception of small area along anterior/lateral edge\nwhich has opened up and is expressing small amount of fibrinous\ndrainage. No spreading erythema or overt purulence. \n- Soft, non-tender thigh and leg\n- Painless ROM of knee and hip, ankle ROM limited by mild pain \n- Fires ___\n- SILT S/S/SP/DP/T distributions\n- 2+ DP pulse, WWP\n.\nAt Discharge:\nRLE\n- skin flap in place w/ good cap refill, +Doppler\n- ___ spatial frame intact\n- thigh and leg soft and non tender\n- 2+ ___ pulse, toes wwp', 'diagnoses': [{'icd_code': 'S86311A', 'desc': 'Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter'}, {'icd_code': 'X58XXXA', 'desc': 'Exposure to other specified factors, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'F0390', 'desc': 'Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety'}, {'icd_code': 'Z85528', 'desc': 'Personal history of other malignant neoplasm of kidney'}], 'summary': "___ 03:10PM LACTATE-1.3\n___ 03:00PM GLUCOSE-84 UREA N-19 CREAT-1.0 SODIUM-137 \nPOTASSIUM-4.1 CHLORIDE-101 TOTAL CO2-26 ANION GAP-14\n___ 03:00PM estGFR-Using this\n___ 03:00PM WBC-5.7 RBC-5.08 HGB-10.4* HCT-36.0* MCV-71* \nMCH-20.5* MCHC-28.9* RDW-18.2* RDWSD-44.9\n___ 03:00PM NEUTS-60.8 ___ MONOS-9.2 EOS-0.7* \nBASOS-0.3 IM ___ AbsNeut-3.48 AbsLymp-1.65 AbsMono-0.53 \nAbsEos-0.04 AbsBaso-0.02\n___ 03:00PM PLT COUNT-247\n___ 03:00PM ___ PTT-28.7 ___\n___ 02:40PM URINE HOURS-RANDOM\n___ 02:40PM URINE UHOLD-HOLD\n___ 02:40PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 02:40PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-6.0 \nLEUK-NEG\n___ 02:40PM URINE RBC-2 WBC-1 BACTERIA-NONE YEAST-NONE \nEPI-0\n___ 02:40PM URINE MUCOUS-RARE\n.\nDISCHARGE LABS:\n___ 05:41AM BLOOD WBC-6.5 RBC-3.04* Hgb-7.0* Hct-23.3* \nMCV-77* MCH-23.0* MCHC-30.0* RDW-19.2* RDWSD-53.9* Plt ___\n___ 02:08PM BLOOD Hct-25.6*\n___ 05:41AM BLOOD Glucose-115* UreaN-7 Creat-0.7 Na-136 \nK-4.3 Cl-103 HCO3-30 AnGap-7*\n___ 05:41AM BLOOD Calcium-8.2* Phos-2.9 Mg-1.8\n___ 02:08PM BLOOD Vanco-18.2\n.\nIMAGING:\nRadiology Report CTA LOWER EXT W/&W/O C & RECONS RIGHT Study \nDate of ___ 11:17 AM \nIMPRESSION: \n1. Patent right lower extremity arteries distal to the mid \nfemoral artery with a good triple vessel runoff. Evaluation is \nlimited by metallic artifact at the ankle and mildly limited \nposterior to the knee with good contrast opacification distally. \n No evidence of pseudoaneurysm formation in the visualized \nportions of the arteries described above. \n2. Extensive collateral veins posterior to the knee and in the \nsubcutaneous fat. \n3. Medial knee soft tissue consistent with free flap although \nexact site of anastomosis between the graft vessel and the \nposterior tibial artery difficult to delineate on this exam. \n4. Redemonstrated complex comminuted mid tibial fracture with \ntibial and \nfibular defects with external hardware in place. \n5. Anterior soft tissue defect with wound VAC in place. \nPostsurgical changes including intramedullary and intraarticular \nfoci of air within the tibia. \n6. Right knee joint effusion which also demonstrates locules of \nnondependent air within it and enhancing synovium, associated \ninfection cannot be excluded completely, if clinically warranted \naspiration of this effusion may be considered to confirm the \nsame. \n.\nRadiology Report CHEST PORT. LINE PLACEMENT Study Date of \n___ 9:38 AM \nNew right PIC line ends in the low SVC. Lungs clear. Heart \nsize normal. No mediastinal or pleural abnormality. \n.\nMICROBIOLOGY:\n___ 8:13 am TISSUE RIGHT TIBIA 1. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: \n Reported to and read back by ___ (___) \n___ @ 10:47\n AM. \n STAPHYLOCOCCUS EPIDERMIDIS. \n Isolated from broth media only, INDICATING VERY LOW \nNUMBERS OF\n ORGANISMS. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n COAG NEG STAPH does NOT require contact precautions, \nregardless of\n resistance. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS EPIDERMIDIS\n | \nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.25 S\nGENTAMICIN------------ =>16 R\nLEVOFLOXACIN---------- =>8 R\nOXACILLIN------------- =>4 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- 2 S\nVANCOMYCIN------------ 1 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\n FUNGAL CULTURE (Final ___: NO FUNGUS ISOLATED. \n.\n___ 8:22 am TISSUE RIGHT TIBIA #3. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: \n IDENTIFICATION AND Sensitivity testing per ___ \n(___). \n STAPHYLOCOCCUS EPIDERMIDIS. \n Isolated from broth media only, INDICATING VERY LOW \nNUMBERS OF\n ORGANISMS. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n COAG NEG STAPH does NOT require contact precautions, \nregardless of\n resistance. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS EPIDERMIDIS\n | \nCLINDAMYCIN----------- =>8 R\nERYTHROMYCIN---------- =>8 R\nGENTAMICIN------------ =>16 R\nLEVOFLOXACIN---------- =>8 R\nOXACILLIN------------- =>4 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- 2 S\nVANCOMYCIN------------ 2 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\n FUNGAL CULTURE (Final ___: NO FUNGUS ISOLATED. \n.\n___ 8:19 am TISSUE RIGHT TIBIA #2. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: \n IDENTIFICATION AND Sensitivity testing per ___ \n(___). \n STAPHYLOCOCCUS EPIDERMIDIS. \n Isolated from broth media only, INDICATING VERY LOW \nNUMBERS OF\n ORGANISMS. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n COAG NEG STAPH does NOT require contact precautions, \nregardless of\n resistance. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS EPIDERMIDIS\n | \nCLINDAMYCIN----------- =>8 R\nERYTHROMYCIN---------- =>8 R\nGENTAMICIN------------ =>16 R\nLEVOFLOXACIN---------- =>8 R\nOXACILLIN------------- =>4 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- 4 S\nVANCOMYCIN------------ 2 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED. \n\n\n FUNGAL CULTURE (Final ___: NO FUNGUS ISOLATED. \n.\n___ 8:25 am SWAB RIGHT TIBIA SWAB. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n WOUND CULTURE (Final ___: \n WORK UP PER ___ ___ ___. \n STAPHYLOCOCCUS EPIDERMIDIS. SPARSE GROWTH. \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n COAG NEG STAPH does NOT require contact precautions, \nregardless of\n resistance. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS EPIDERMIDIS\n | \nCLINDAMYCIN----------- =>8 R\nERYTHROMYCIN---------- =>8 R\nGENTAMICIN------------ =>16 R\nLEVOFLOXACIN---------- =>8 R\nOXACILLIN------------- =>4 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- 2 S\nVANCOMYCIN------------ 1 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): \n A swab is not the optimal specimen for recovery of \nmycobacteria or\n filamentous fungi. A negative result should be \ninterpreted with\n caution. Whenever possible tissue biopsy or aspirated \nfluid should\n be submitted. \n NO MYCOBACTERIA ISOLATED. \n\n FUNGAL CULTURE (Preliminary): \n NO FUNGUS ISOLATED. \n A swab is not the optimal specimen for recovery of \nmycobacteria or\n filamentous fungi. A negative result should be \ninterpreted with\n caution. Whenever possible tissue biopsy or aspirated \nfluid should\n be submitted. \n.\n___ 8:50 am TISSUE PROXIMAL RIGHT TIBIA BONE. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH. \n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): \n\n FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. \n\n POTASSIUM HYDROXIDE PREPARATION (Final ___: \n NO FUNGAL ELEMENTS SEEN.\nThe patient was admitted to the orthopaedic surgery service on \n___ and on ___ underwent: 1. Irrigation and debridement \nincluding skin, subcutaneous tissue, muscle, and bone, right \nopen tibia fracture; 2. Removal of antibiotic-impregnated cement \nspacer; 3. Application of VAC dressing to right tibia. He \ntolerated the procedure well. \n.\nID was consulted on ___ for assistance with his chronic RLE \ninfection ane per their recommendations he was started on IV \nvancomycin/cefempine/flagyl. Plastic Surgery was consulted \n___ for his h/o free tissue transfer and assistance with \npotential flap coverage. \n.\nOn ___ he was taken back to the OR with Orthopaedic Surgery \nfor 1. Removal deep implant IM nail right tibia; 2. Irrigation \nand debridement of fracture skin to bone right tibia; 3. \nApplication of ___ type multiplanar external fixator, 4. \nVac placement. He tolerated the procedure well. His vac was \nchanged every 3 days. \n.\nOn ___ he returned to OR w/ Orthopaedics and Plastic \nSurgery. Orthopaedics performed 1. Adjustment of external \nfixator, right tibia, under anesthesia; 2. Application of \nnonbio-absorbable drug delivery device, antibiotic cement spacer \nto right tibia. Plastic Surgery performed 1. Open debridement of \nright lower extremity, 7 x 8 cm including skin, subcutaneous \ntissue, muscle and bone; 2. Free tissue transfer from left \nthigh, 7 x 26 cm, anterior lateral thigh microvascular flap 3. \nPlacement of tobramycin and vancomycin spacer right lower \nextremity. He tolerated the procedure well. \n.\nHe was transferred to the Plastic Surgery service post \noperatively. His flap was monitored closely, according to \nprotocol and his leg was kept elevated. ___ was consulted and \nrecommended discharge to home with services. \n.\nNeuro: Post-operatively, the patient had Acute Pain Service \nfollowing. He had nerve catheters in place as well as received \nPO dialudid, MS ___, tylenol, and gabapentin with good \neffect. The nerve catheters were d/c within ___ days post \noperatively. \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. His diet was advanced when appropriate, \nwhich was tolerated well. He was also started on a bowel regimen \nto encourage bowel movement. Foley was removed on POD#2. Intake \nand output were closely monitored. \n.\nID: ID continued to follow along and review all of the OR \nculture data. Patient continued on IV vancomycin, cefepime and \nflagyl and then was transitioned to just IV vancomycin on \n___. He will be discharged home on Vancomycin 1gm IV Q8H for \napproximately 28 more days and will be followed as an outpatient \nby ID. The patient's temperature was closely watched for signs \nof infection. \n.\nProphylaxis: The patient received subcutaneous heparin and ASA \nduring this stay, and was allowed to get up and ambulate with \ncrutches for 15 minutes TID by POD #6. He will be discharged \nhome on ASA for flap protection and lovenox 40 SC daily for DVT \nprophylaxis while has restricted activity. \n\nAt the time of discharge on hospital day# 21, the patient was \ndoing well, afebrile with stable vital signs, tolerating a \nregular diet, voiding without assistance, and pain was well \ncontrolled."}}
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{'final_diagnoses': ['Open tibia fracture', 'RLE infection'], 'procedures': ['1. Irrigation and debridement including skin, subcutaneous\n tissue, muscle, and bone, right open tibia fracture.\n2. Removal of antibiotic-impregnated cement spacer.\n3. Application of VAC dressing to right tibia.', '1. Removal deep implant IM nail right tibia.\n2. Irrigation and debridement of fracture skin to bone right \ntibia.\n3. Application of Il type multiplanar external fixator.', '1. Adjustment of external fixator, right tibia, under\n anesthesia.\n2. Application of nonbio-absorbable drug delivery device,\n antibiotic cement spacer to right tibia.', '1. Open debridement of right lower extremity, 7 x 8 cm\n including skin, subcutaneous tissue, muscle and bone.\n2. Free tissue transfer from left thigh, 7 x 26 cm,\n anterior lateral thigh microvascular flap.\n3. Placement of tobramycin and vancomycin spacer right\n lower extremity.'], 'visit_summary': "The patient was admitted to the orthopaedic surgery service on \n___ and on ___ underwent: 1. Irrigation and debridement \nincluding skin, subcutaneous tissue, muscle, and bone, right \nopen tibia fracture; 2. Removal of antibiotic-impregnated cement \nspacer; 3. Application of VAC dressing to right tibia. He \ntolerated the procedure well. \n.\nID was consulted on ___ for assistance with his chronic RLE \ninfection ane per their recommendations he was started on IV \nvancomycin/cefempine/flagyl. Plastic Surgery was consulted \n___ for his h/o free tissue transfer and assistance with \npotential flap coverage. \n.\nOn ___ he was taken back to the OR with Orthopaedic Surgery \nfor 1. Removal deep implant IM nail right tibia; 2. Irrigation \nand debridement of fracture skin to bone right tibia; 3. \nApplication of ___ type multiplanar external fixator, 4. \nVac placement. He tolerated the procedure well. His vac was \nchanged every 3 days. \n.\nOn ___ he returned to OR w/ Orthopaedics and Plastic \nSurgery. Orthopaedics performed 1. Adjustment of external \nfixator, right tibia, under anesthesia; 2. Application of \nnonbio-absorbable drug delivery device, antibiotic cement spacer \nto right tibia. Plastic Surgery performed 1. Open debridement of \nright lower extremity, 7 x 8 cm including skin, subcutaneous \ntissue, muscle and bone; 2. Free tissue transfer from left \nthigh, 7 x 26 cm, anterior lateral thigh microvascular flap 3. \nPlacement of tobramycin and vancomycin spacer right lower \nextremity. He tolerated the procedure well. \n.\nHe was transferred to the Plastic Surgery service post \noperatively. His flap was monitored closely, according to \nprotocol and his leg was kept elevated. ___ was consulted and \nrecommended discharge to home with services. \n.\nNeuro: Post-operatively, the patient had Acute Pain Service \nfollowing. He had nerve catheters in place as well as received \nPO dialudid, MS ___, tylenol, and gabapentin with good \neffect. The nerve catheters were d/c within ___ days post \noperatively. \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. His diet was advanced when appropriate, \nwhich was tolerated well. He was also started on a bowel regimen \nto encourage bowel movement. Foley was removed on POD#2. Intake \nand output were closely monitored. \n.\nID: ID continued to follow along and review all of the OR \nculture data. Patient continued on IV vancomycin, cefepime and \nflagyl and then was transitioned to just IV vancomycin on \n___. He will be discharged home on Vancomycin 1gm IV Q8H for \napproximately 28 more days and will be followed as an outpatient \nby ID. The patient's temperature was closely watched for signs \nof infection. \n.\nProphylaxis: The patient received subcutaneous heparin and ASA \nduring this stay, and was allowed to get up and ambulate with \ncrutches for 15 minutes TID by POD #6. He will be discharged \nhome on ASA for flap protection and lovenox 40 SC daily for DVT \nprophylaxis while has restricted activity. \n\nAt the time of discharge on hospital day# 21, the patient was \ndoing well, afebrile with stable vital signs, tolerating a \nregular diet, voiding without assistance, and pain was well \ncontrolled.", 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H pain, HA, T>100 degrees', '2. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*30 Capsule Refills:*1', '3. Senna 17.2 mg PO BID \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp \n#*28 Tablet Refills:*2', '4. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '5. Aspirin 121.5 mg PO DAILY \nRX *aspirin 81 mg 1.5 tablet(s) by mouth once a day Disp #*45 \nTablet Refills:*0', '6. PARoxetine 40 mg PO DAILY', '7. Gabapentin 300 mg PO TID \nRX *gabapentin 300 mg 1 capsule(s) by mouth three times a day \nDisp #*90 Capsule Refills:*2', '8. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nRX *hydromorphone 2 mg ___ tablet(s) by mouth Every ___ hours \nDisp #*72 Tablet Refills:*0', '9. Morphine SR (MS ___ 30 mg PO Q12H \nRX *morphine [MS ___ 30 mg 1 tablet(s) by mouth every twelve \n(12) hours Disp #*14 Tablet Refills:*0', '10. Enoxaparin Sodium 40 mg SC DAILY Duration: 2 Weeks \nStart: Today - ___, First Dose: Next Routine Administration \nTime \nRX *enoxaparin 40 mg/0.4 mL 40 mg subcutaneous once a day Disp \n#*14 Syringe Refills:*3', '11. Vancomycin 1000 mg IV Q 8H \nRX *vancomycin 1 gram 1 gm IV every eight (8) hours Disp #*84 \nVial Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 70, 'gender': 'M', 'symptoms': 'confusion', 'medical_history': ['- Aflutter: Dx ___ when had dCHF. LVEF at thta time was \n40-45% but has since improved to 55%. S/p multiple DCCVs most \nrecent in ___. Tried on amiodarone but developed pulmonary \ntoxicity. On sotalol which was titrated from 80 mg BID to ___ mg \nBID. On Pradaxa until GIB, then switched to ASA late ___.', '- Cardiomyopathy most recent echo with LVEF>55%', '- DM2: followed by ___. HbA1c: 8.2 ___', '- HLD: LDL ___', '- HTN', '- COPD', '- Hypothyroidism', '- Spinal stenosis', '- Memory loss / cognitive dysfunction', '- R knee arthroscopy', '- Hemorrhoids', '- h/o lung nodule', '- Depression', '- Hx of thrombocytopenia', '- Tobacco abuse', '- BLE LUMBAR RADICULOPATHY'], 'family_history': 'significant for CAD', 'present_illness': '___ with h/o atrial fibrillation on warfarin, CHF (EF55%), IDDM, \nlow level cognitive decline, treated for UTI 2 weeks ago, \npresents with confusion. \nIn the last ___ days has had increased lethargy, urinary \nfrequency, and confusion, including inability to recall \nchildren\'s names, thought someone else (a man) had been in her \napartment all night, called ___ with concern for one of her \nchildren having been injured. \n2 days ago also had a fall at night when trying to steady \nherself, fell reportedly onto bottom but this was unwitnessed. \nGot herself up. Family also feel that speech is slightly \nslurred, this often occurs when she is drowsy. Pt also reports \nbilateral shoulder pain extending into back, unable to further \ndescribe or specify. \nPer referral from Dr. ___. Pt\'s daughter arrived to \noffice very concerned about her mothers ability to function \nsafely at home given her degree of confusion, lack of safety \nawareness, and paranoia. She had dropped her mother off in the \nED. Her daughter feels if she is not admitted medically, she \nwould require a rehab stay vs geriatric psychiatry admission. \nRecommend psych consult to consider whether a voluntary \npsychiatric admission is appropriate, preferably to ___ \n___. \nIn the ED, initial vitals were: 97.2 122 156/83 16 99% ra \n- EKG: afib, 107 \n- Labs were significant for: WBC 4.4, Hb 14.3, plt 128, BUN/Cr \n34/1.2, lactate 2.5, AST/ALT 42/58, T bili 0.2, proBNP 1233, \ntrop <0.01, INR 4.5 \n- UA negative \n- Imaging revealed: neg CT head and C-spine, CXR diffuse chronic \ninterstitial markings \n- The patient was given: 850cc NS and 20 IV lasix \n- Prior to transfer, pt given 2.5 IV metop for rapid afib in \nhigh 110s to low 120s \nVitals prior to transfer were: 98.2 111 116/98 20 97% RA \nUpon arrival to the floor, pt reports she is here because of \n"difficulty or slowing of her mind". She reports she is unsure \nabout the timing of this process but believes maybe 2 months or \nso. She has not noticed any recent change but she reports she \ndoes not remember well or pick up on changes. She denies CP, \nSOB, palpitations, dizziness. She reports she believes her fall \nwas 2 weeks ago. Pt denies visual and auditory hallucinations. \nREVIEW OF SYSTEMS: \n(+) Per HPI', 'medications': [{'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Desmopressin Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NAS', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcium Gluconate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Alendronate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QFRI', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': '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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', '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': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', '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}]}, 'clinical_findings': {'labs': [{'value': '-5', 'valuenum': -5.0, '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': '1.04', 'valuenum': 1.04, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '169', 'valuenum': 169.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '450', 'valuenum': 450.0, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '33.3', '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': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78.9', 'valuenum': 78.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '323', 'valuenum': 323.0, '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': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, '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': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, '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': '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': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1939.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 182.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '262', 'valuenum': 262.0, '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': '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.34', 'valuenum': 0.34, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.56', 'valuenum': 0.56, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, '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': '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': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, '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': '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': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', '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': '25.3', 'valuenum': 25.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, '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': '67', 'valuenum': 67.0, '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': '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': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2874.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '242', 'valuenum': 242.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '3.41', 'valuenum': 3.41, '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': '___', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, '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': '___', 'valuenum': 2227.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '26.0', 'valuenum': 26.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 0.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mg/dL', 'ref_range_lower': 15.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, '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': '___', 'valuenum': 154.0, '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.'}], 'exams': 'On Admission:\nVitals: 97.3, 105/55, 128, 20, 97% RA \nGeneral: elderly woman, sitting up on edge of bed, \nwell-appearing, well-groomed, in NAD \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI \nNeck: Supple, JVP not elevated \nCV: irregular, rates in 110s, no murmurs appreciated \nLungs: very slight babasilar rales, breathing comfortably \nAbdomen: soft, NT, ND \nGU: No foley \nExt: Warm, well perfused, no ___ edema \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, normal finger to nose, ___ forward and \nbackwards, A&Ox3, knows current and 2 preceding presidents, can \ndo some simple calculation with coins, only 1 successful step in \nserial 7s (after 3 attempts), normal finger to nose with some \ndifficulty in getting started because of which finger to use \nPsych: pleasant and interactive with normal affect\n\nOn Discharge:\nPhysical Exam:\nVitals: Tm/Tc 97.5, 103/59, 78 (70-90s), 18, 95 on RA \nWt: 72.3 kg (71.8kg)\nGeneral: AAOx3, comfortable appearing, in NAD. Slurred speech.\nMSE: Able to do days of week backwards, recalls ___ words at 5 \nminutes\nHEENT: NCAT, EOMI, PERRL. Sclera anicteric, conjunctiva pink. \nMMM. OP clear.\nNeck: supple, no LAD, no JVP elevation\nLungs: CBTA, no w/r/r\nCV: irregular rate and rhythm, normal S1 and S2, no m/g/r\nAbdomen: NABS, soft, non-distended, non-tender. No HSM.\nGU: no foley\nExt: WWP. 2+ peripheral pulses. No edema.\nNeuro: CNs II-XII intact. Motor and sensory function grossly \nintact.', 'diagnoses': [{'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '2537', 'desc': 'Iatrogenic pituitary disorders'}, {'icd_code': 'V5865', 'desc': 'Long-term (current) use of steroids'}, {'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': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': 'V153'}], 'summary': "Labs on Admission:\n=================\n___ 04:25PM BLOOD WBC-4.4 RBC-4.84 Hgb-14.3 Hct-40.9 MCV-85 \nMCH-29.6 MCHC-35.0 RDW-15.4 Plt ___\n___ 04:25PM BLOOD ___ PTT-46.6* ___\n___ 04:25PM BLOOD ALT-58* AST-42* AlkPhos-127* TotBili-0.2\n___ 04:25PM BLOOD cTropnT-<0.01\n___ 04:25PM BLOOD proBNP-1233*\n___ 04:25PM BLOOD Albumin-4.0 Calcium-9.6 Phos-3.7 Mg-2.1\n___ 04:25PM BLOOD Digoxin-1.6\n___ 04:25PM BLOOD Valproa-24*\n___ 04:40PM BLOOD Lactate-2.5*\n\nLabs on discharge:\n=================\n___ 06:41AM BLOOD ___ PTT-29.8 ___\n___ 06:41AM BLOOD Glucose-110* UreaN-32* Creat-1.1 Na-141 \nK-4.0 Cl-103 HCO3-23 AnGap-19\n\nMICRO:\n=====\nBlood cultures:\nUrine culture:\n\nIMAGING:\n=======\nCT head ___:\n-No acute intracranial process. \n\nCT C-spine ___:\n-No fracture or malalignment. \n\nCXR ___:\n-Diffuse chronic interstitial markings in the lungs without \nsuperimposed acute cardiopulmonary process\n___ with PMH notable for depression, afib on warfarin, CHF (EF \n55%), IDDM (Hba1c unknown), CKD (Cr 1.1) and UTIs (most recent 2 \nweeks ago) who presents with ___ weeks of confusion, visual \nhallucinations, and agitation, all in the setting of multiple \npsychiatric medication changes and a chronic decline in \ncognition. \n\nACTIVE ISSUES:\n=============\n# Altered mental status most likely due to acute delirium due to \nmedication changes on top of a chronic dementia as evidenced by \nher decline over the past year. Other etiologies of delirium are \nunlikely given that infectious workup was negative (normal CXR, \nUA, and WBC), electrolytes were normal, and CNS imaging was \nwithout evidence of intracranial process with no localizing \nneurological deficits on exam. Prior to admission, her PCP \nincreased her clonazepam and stopped her buspar. Her outpatient \npsychiatrist 1 month prior to admission started her on depakote \n(level = 24 on admission) and tapered her off her sertraline \n(last dose 1 week prior to admission). Patient reports depressed \nmood currently with multiple neurovegetative symptoms. Further, \nboth the patient and family report a chronic decline in \ncognition. Thus, medication changes together with her chronic \nmood disorder and possible underlying dementia most likely \nexplain her acute change in mental status. Psychiatry was \nconsulted who recommended down titrating her clonazepam. At the \ntime of discharge, her clonazepam was changed to 0.5mg QAM/QHS \nand 0.25mg in the afternoon. Due to patient's sedation, a couple \ndoses were held, she displayed no evidence of withdrawal. \nPsychiatry recommended increasing her quetiapine to 100mg from \n75mg, however, her QTc on admission was around 500, therefore \nthis was not done. Her mental status began to clear by \ndischarge, however, she continued to struggle with short-term \nmemory.\n\n# Fall: Pt unable to describe events surrounding fall, however, \nshe reports unsteadiness while walking. There was no head strike \nor LOC, syncopal symptoms, or post-ictal confusion concerning \nfor seizure. Thus, most likely her fall is related to \ndeconditioning and her AMS. ___ and OT were consulted, who \nrecommended rehab after discharge. Given daughter's preference, \npatient is going home with 24 hour care and ___ services.\n\n# Afib (CHADS score 4). Her rates were ___ since admission. \nHer warfarin was held given supratherapeutic INR (4.5). She was \nrestarted on warfarin on ___ with most recent dose of 5mg \non ___ and INR 1.2 on ___. She was continued on home \ndigoxin and metoprolol. \n\n# dCHF: Pt with slight bibasilar rales on initial exam but \nrelatively euvolemic on following exams with CXR consistent with \nprior without significant pulmonary edema. BNP was similar to \nprior values. She was continued on home lasix, spironolactone, \nand metoprolol.\n\nCHRONIC ISSUES:\n==============\n# IDDM: \n- Continued lantus and placed her on ISS.\n- Held glipizide and restarted prior to discharge. \n\n# CKD: Cr stayed around 1.2 which is close to baseline of \n0.9-1.1. \n\n# Hypothyroidism: Continued levothyroxine, normal TSH earlier \nthis month. \n\n# GERD: Continued home PPI \n\n# Thrombocytopenia: mild and stable \n\nTRANSITIONAL ISSUES:\n===================\n- Clonazepam was down titrated to 0.5mg QAM and QPM, with 0.25mg \nafternoon dose. Inpatient psychiatry and her outpatient \npsychiatrist agree with plan to continue tapering this down. Due \nto patient sedation, clonazepam and seroquel were held at times. \nGiven the dose and length of time patient has been on \nclonazepam, it is important to ensure if she misses a dose for \nsedation that she be monitored for withdrawal. \n- Quatiapine remained at 75mg QHS, if QTc is normal, psychiatry \nrecommends increasing to 100mg QHS. Her quetapine was not \nincreased further given concerns over her QTc. \n- Outpatient neuropsychology testing is recommended to evaluate \nfor dementia\n- Physical and occupational therapy evaluated the patient, who \nboth agree ___ rehab is recommended\n- Warfarin was held because INR was 4.5 on admission. This \ndowntrended to a nadir of 1.2 on ___. She was restarted on \n___ at her home dose of 5mg 6xs/week and 2.5mg on ___. \nHer INR needs to be rechecked ___ with the results faxed to \n___ clinic at ___. \n- CODE STATUS: Resuscitate but do not intubate (confirmed with \ndaughter, ___, her healthcare proxy)\n- CONTACT: ___, daughter, who is healthcare proxy \nPhone number: ___\nCell phone number: ___"}}
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{'final_diagnoses': ['Altered mental status', 'Cardiomyopathy (EF>55%)', 'Atrial fibrillation', 'Diabetes Mellitus Type II', 'COPD', 'Mood disorder NOS'], 'procedures': ['None'], 'visit_summary': "___ with PMH notable for depression, afib on warfarin, CHF (EF \n55%), IDDM (Hba1c unknown), CKD (Cr 1.1) and UTIs (most recent 2 \nweeks ago) who presents with ___ weeks of confusion, visual \nhallucinations, and agitation, all in the setting of multiple \npsychiatric medication changes and a chronic decline in \ncognition. \n\nACTIVE ISSUES:\n=============\n# Altered mental status most likely due to acute delirium due to \nmedication changes on top of a chronic dementia as evidenced by \nher decline over the past year. Other etiologies of delirium are \nunlikely given that infectious workup was negative (normal CXR, \nUA, and WBC), electrolytes were normal, and CNS imaging was \nwithout evidence of intracranial process with no localizing \nneurological deficits on exam. Prior to admission, her PCP \nincreased her clonazepam and stopped her buspar. Her outpatient \npsychiatrist 1 month prior to admission started her on depakote \n(level = 24 on admission) and tapered her off her sertraline \n(last dose 1 week prior to admission). Patient reports depressed \nmood currently with multiple neurovegetative symptoms. Further, \nboth the patient and family report a chronic decline in \ncognition. Thus, medication changes together with her chronic \nmood disorder and possible underlying dementia most likely \nexplain her acute change in mental status. Psychiatry was \nconsulted who recommended down titrating her clonazepam. At the \ntime of discharge, her clonazepam was changed to 0.5mg QAM/QHS \nand 0.25mg in the afternoon. Due to patient's sedation, a couple \ndoses were held, she displayed no evidence of withdrawal. \nPsychiatry recommended increasing her quetiapine to 100mg from \n75mg, however, her QTc on admission was around 500, therefore \nthis was not done. Her mental status began to clear by \ndischarge, however, she continued to struggle with short-term \nmemory.\n\n# Fall: Pt unable to describe events surrounding fall, however, \nshe reports unsteadiness while walking. There was no head strike \nor LOC, syncopal symptoms, or post-ictal confusion concerning \nfor seizure. Thus, most likely her fall is related to \ndeconditioning and her AMS. ___ and OT were consulted, who \nrecommended rehab after discharge. Given daughter's preference, \npatient is going home with 24 hour care and ___ services.\n\n# Afib (CHADS score 4). Her rates were ___ since admission. \nHer warfarin was held given supratherapeutic INR (4.5). She was \nrestarted on warfarin on ___ with most recent dose of 5mg \non ___ and INR 1.2 on ___. She was continued on home \ndigoxin and metoprolol. \n\n# dCHF: Pt with slight bibasilar rales on initial exam but \nrelatively euvolemic on following exams with CXR consistent with \nprior without significant pulmonary edema. BNP was similar to \nprior values. She was continued on home lasix, spironolactone, \nand metoprolol.\n\nCHRONIC ISSUES:\n==============\n# IDDM: \n- Continued lantus and placed her on ISS.\n- Held glipizide and restarted prior to discharge. \n\n# CKD: Cr stayed around 1.2 which is close to baseline of \n0.9-1.1. \n\n# Hypothyroidism: Continued levothyroxine, normal TSH earlier \nthis month. \n\n# GERD: Continued home PPI \n\n# Thrombocytopenia: mild and stable \n\nTRANSITIONAL ISSUES:\n===================\n- Clonazepam was down titrated to 0.5mg QAM and QPM, with 0.25mg \nafternoon dose. Inpatient psychiatry and her outpatient \npsychiatrist agree with plan to continue tapering this down. Due \nto patient sedation, clonazepam and seroquel were held at times. \nGiven the dose and length of time patient has been on \nclonazepam, it is important to ensure if she misses a dose for \nsedation that she be monitored for withdrawal. \n- Quatiapine remained at 75mg QHS, if QTc is normal, psychiatry \nrecommends increasing to 100mg QHS. Her quetapine was not \nincreased further given concerns over her QTc. \n- Outpatient neuropsychology testing is recommended to evaluate \nfor dementia\n- Physical and occupational therapy evaluated the patient, who \nboth agree ___ rehab is recommended\n- Warfarin was held because INR was 4.5 on admission. This \ndowntrended to a nadir of 1.2 on ___. She was restarted on \n___ at her home dose of 5mg 6xs/week and 2.5mg on ___. \nHer INR needs to be rechecked ___ with the results faxed to \n___ clinic at ___. \n- CODE STATUS: Resuscitate but do not intubate (confirmed with \ndaughter, ___, her healthcare proxy)\n- CONTACT: ___, daughter, who is healthcare proxy \nPhone number: ___\nCell phone number: ___", 'medications_prescribed': ['1. ClonazePAM 0.5 mg PO QAM', '2. ClonazePAM 0.25 mg PO AFTERNOON ___', '3. ClonazePAM 0.5 mg PO QHS \nhold for sedation, RR<10 and SBP <100', '4. Digoxin 0.125 mg PO DAILY', '5. Divalproex (DELayed Release) 250 mg PO QHS', '6. Divalproex (DELayed Release) 125 mg PO QAM', '7. Docusate Sodium 100 mg PO BID', '8. Furosemide 40 mg PO DAILY', '9. Glargine 40 Units Bedtime', '10. Levothyroxine Sodium 100 mcg PO DAILY', '11. Multivitamins 1 TAB PO DAILY', '12. Omeprazole 40 mg PO DAILY', '13. QUEtiapine Fumarate 75 mg PO QHS', '14. QUEtiapine Fumarate 50 mg PO QAM', '15. QUEtiapine Fumarate 25 mg PO DAILY IN THE AFTERNOON', '16. Spironolactone 25 mg PO DAILY', '17. Warfarin 5 mg PO 6X/WEEK (___)', '18. Warfarin 2.5 mg PO 1X/WEEK (FR)', '19. GlipiZIDE XL 10 mg PO DAILY', '20. Hydrocortisone Cream 1% 1 Appl TP DAILY:PRN hemorrhoids', '21. Metoprolol Succinate XL 50 mg PO BID', '22. Outpatient Lab Work\nINR check on ___ Please fax results to ___']}
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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': 'dyspnea', 'medical_history': ['HLD', 'AS s/p AVR', 'A-Fib'], 'family_history': 'Pulmonary fibrosis on materal side.', 'present_illness': '___ y/o male with AS s/p AVR, c/b afib, progressive SOB (healthy\nbefore all this a couple of years ago), over last ___ year. Has\nmainly been followed at ___. \nPrveiously no O2 requirement, now on ___ L NC. Unable to speak\nsentences or do any activity due to severe SOB. Recent \nadmission in ___ with bronchoscopy at ___. He has been \ntrialed on ctyoxan and prednisone for unclear diagnosis. \nAdmitted\nto ___ in ___ on ___, for chest pain and worsening \ndyspnea. CXR showed pneumomediastinum of unclear chronicity. \nChest CT in ___ showed significant fibrotic changes. He was \ninitially treated with Abx, then discharged on Esbriet for \npresumed IPF; however, pulmonology at ___ still not clear \nof the exact diagnosis. He has not had any improvement with \nEsbriet. Saw cardiologist in last 2 weeks, TTE was reportedly \nwnl. Of note, has bradycardia with sleep (30s). Has appt with \n___ on ___, however concern that he was too unstable to \ntravel given O2 requirement. Went to ___ yesterday, ___ ongoing \nSOB - referred to\nED at ___ and readmitted. CXR unclear if new or old\npneumomediastinum. On 6 L NC. He is being transferred to the \nMICU for further evaluation of his pulmonary disease. \n\nPer patient, he has been having progreesively worsening dyspnea \nand dyspnea on exertion over the last ___ years. Patient reports \nhad 2 episodes of acute decline, in ___ and ___. \n Patient does not recall any particular triggers but does report \nthat ___ years ago, had walls taken down at work which had \nsignificant amount of "black mold". No travels within the last \nfew years. Additionally, patient reports being on amiodarone \nfor approximately 1 week around the time of aortic valve \nreplacement ___ years ago.\n\nROS significant for dry cough and 50lbs weight loss over the \nlast year. Denies f/c/n/v, night sweats, chest pain, ___ edema, \n___ pain, rash, joint pain, myalgia.', 'medications': [{'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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate (Oral Soln.)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': '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': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'MetRONIDAZOLE (FLagyl)', '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': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', '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', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': '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': 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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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 Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Metoprolol Tartrate', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin Oral Liquid', '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': 'IV', 'frequency': 'ONCE MR1', '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': 'Furosemide', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 0.5, '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 0.5,. 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': 89.0, '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': '4.1', 'valuenum': 4.1, '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': '13', 'valuenum': 13.0, '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': 'MANY.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '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': 'LG.'}, {'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': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '>182*.'}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': '118', 'valuenum': 118.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, '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': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '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': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '85', 'valuenum': 85.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '99', 'valuenum': 99.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'L/min', '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': '7.45', 'valuenum': 7.45, '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': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 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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': '22.1', 'valuenum': 22.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '11', 'valuenum': 11.0, '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, 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28.0, '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': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': 'LARGE PLTS SEEN.'}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, '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': 'CHECKED FOR NRBCS.'}, {'value': '27.4', 'valuenum': 27.4, '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': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 248.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LARGE PLATELET PRESENT.'}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': "VERIFIED BY SMEAR. CHECKED FOR NRBC'S."}, {'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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.3,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (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': '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '3.6', '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': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '308', 'valuenum': 308.0, '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': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, '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': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', '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': '321', 'valuenum': 321.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 263.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': 'LARGE PLATELETS PRESENT.'}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSINO PE:\n\nVitals- afebrile BP: 111/86 P: 72 R:18 O2: 100% on NC ___ \nHeight 67in, Weight 160lbs\nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: dry crackles bilaterally, more pronounced in lower \nfields, scant wheeze. Speaking full sentences but with mild \nshortness of breath\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, non-tender, non-distended, bowel sounds present, no \nrebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: no rash\nNEURO: alert and oriented x3. CN2-12 intact. Moving all \nextremities. Sensation to light touch intact throughout.\n\nDISCHARGE PE:\n\nVS: 97.9; 96/63; 69; 18; 98%5L\nGENERAL: NAD, alert, interactive \nHEENT: NC/AT, sclerae anicteric, MMM \nLUNGS: Bilateral velcro crackles to ___ way up lung. \nHART: RRR, ___ systolic ejection murmur appreciated over LUSB. \nABDOMEN: NABS, soft/NT/ND. \nEXTREMITIES: WWP \nNEURO: awake, A&Ox3 ', 'diagnoses': [{'icd_code': '8208', 'desc': 'Closed fracture of unspecified part of neck of femur'}, {'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '99591', 'desc': 'Sepsis'}, {'icd_code': '99674', 'desc': 'Other complications due to other vascular device, implant, and graft'}, {'icd_code': '45381', 'desc': 'Acute venous embolism and thrombosis of superficial veins of upper extremity'}, {'icd_code': '45384', 'desc': 'Acute venous embolism and thrombosis of axillary veins'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '00845', 'desc': 'Intestinal infection due to Clostridium difficile'}, {'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': 'E8889'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '4264', 'desc': 'Right bundle branch block'}, {'icd_code': '60001', 'desc': 'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': '04104', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]'}, {'icd_code': '79311', 'desc': 'Solitary pulmonary nodule'}, {'icd_code': 'V1652', 'desc': 'Family history of malignant neoplasm, bladder'}], 'summary': "ADMISSION LABS:\n\n___ 03:41AM BLOOD WBC-5.6 RBC-3.79* Hgb-13.1* Hct-36.8* \nMCV-97 MCH-34.6* MCHC-35.6* RDW-14.7 Plt ___\n___ 03:41AM BLOOD Neuts-66.9 ___ Monos-8.6 Eos-0.3 \nBaso-0.1\n___ 03:41AM BLOOD ___ PTT-33.1 ___\n___ 03:41AM BLOOD Glucose-87 UreaN-18 Creat-0.5 Na-136 \nK-3.8 Cl-100 HCO3-28 AnGap-12\n___ 03:41AM BLOOD Calcium-8.7 Phos-3.1 Mg-2.2\n\nDISCHARGE LABS: Hypersensitivity Pneumonitis panel pending\n\nMICRO: None this admission\n\nSTUDIES/IMAGING:\n\nCXR ___: Cardiac size is top-normal. There is \npneumomediastinum. \nThere is no pleural effusion. There are low lung volumes. \nDiffuse predominantly peripheral and basal interstitial \nreticular opacities are likely chronic, reflecting interstitial \nlung disease. Allowing in the difference in inspiratory effort, \nare grossly unchanged from ___. There is minimal increased \ndensity in the left base likely atelectasis. Sternal wires are \naligned. Patient is status post AVR and likely CABG. \n\nCXR ___: Cardiomediastinal silhouette is unchanged. Interval \ndecrease in still present pneumomediastinum is noted. No \nappreciable pleural effusion is seen. Appearance of the lung \nparenchyma is similar to previous study. \n___ w/ h/o AS s/p AVR, transferred from ___) \nfor further evaluation of his progressive hypoxic respiratory \nfailure (chronic ___ O2 use) and interstitial lung disease. \n\n# Interstitial lung disease, NOS: Wide differential for \ninterstitial lung disease. Differential included \nidiopathic/autoimmune, chronic aspiration, chronic pulm edema, \nenvironmental exposure, and drug-induced. Most likely idiopathic \ngiven family history and no significant drug/environment \nexposure and no long standing pulmonary edema or aspiration per \nhistory. Patient has had significant previous workup at \n___ (documented to OMR note by pulmonology dated \n___. Unfortunately, patient has failed treatment with \nsteroids, cytoxan. Follows closely with palliative care at ___. \nCurrently taking Esbriet per pulmonologist at \n___. Seen by pulmonary and Dr. ___ \nadmission who sent hypersensitivity panel and recommended \noutpatient evaluation for possible lung transplant at ___. \nDischarge patient on a steroid taper and discontinued patient's \ncytoxan. Continued bactrim ppx.\n\n#Pneumomediastinum - present on CT in ___ and no findings \nof crepitus on exam. HD stable. Serial CXR this admission showed \nmild improvement in pneumomediasinum. Felt to be likely ___ to \npatient's ILD. Increased bowel regimen to prevent straining with \ndefectation that could worsen/exacerbate pneumomediastinum.\n\n#Hypotension - patient frequently hypotensive to 80-90s systolic \nthis admission. Largely asymptomatic. Had some lightheaded ness \nassociated with standing, however felt to be ___ significant \ndeconditioning. Patient taking both digoxin and metoprolol for \nAfib. Reduced dose of metoprolol. Can consider discontinuing \ndigoxin in the future if patient has persistent issues with \nblood pressure and HR was stable this admission.\n\nCHRONIC ISSUES:\n\n#AS s/p AVR, a-fib - Continued home xarelto, digoxin, \nmetoprolol, aspirin \n#HLD - Continued Atorvastatin 40mg qD\n#CAD - Continued ASA 81mg, Metoprolol 25mg XL, Nitro PRN\n#GERD - Continued Omeprazole 20mg qD\n#Anxiety - continued home ativan\n#DEF. - Continued Cyanocobalamin 1000mcg PO qD, Vit D 1000U qD, \nMV\n#Constipation - continued Miralax, Senna, colace. Added \nbisacodyl suppositories PRN."}}
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{'final_diagnoses': ['Pulmonary Fibrosis', 'Atrial Fibrillation', 'Constipation', 'Hyperlipidemia', 'Coranary Artery Disease', 'Gastroesophageal Reflux Disease'], 'procedures': ['none'], 'visit_summary': "___ w/ h/o AS s/p AVR, transferred from ___) \nfor further evaluation of his progressive hypoxic respiratory \nfailure (chronic ___ O2 use) and interstitial lung disease. \n\n# Interstitial lung disease, NOS: Wide differential for \ninterstitial lung disease. Differential included \nidiopathic/autoimmune, chronic aspiration, chronic pulm edema, \nenvironmental exposure, and drug-induced. Most likely idiopathic \ngiven family history and no significant drug/environment \nexposure and no long standing pulmonary edema or aspiration per \nhistory. Patient has had significant previous workup at \n___ (documented to OMR note by pulmonology dated \n___. Unfortunately, patient has failed treatment with \nsteroids, cytoxan. Follows closely with palliative care at ___. \nCurrently taking Esbriet per pulmonologist at \n___. Seen by pulmonary and Dr. ___ \nadmission who sent hypersensitivity panel and recommended \noutpatient evaluation for possible lung transplant at ___. \nDischarge patient on a steroid taper and discontinued patient's \ncytoxan. Continued bactrim ppx.\n\n#Pneumomediastinum - present on CT in ___ and no findings \nof crepitus on exam. HD stable. Serial CXR this admission showed \nmild improvement in pneumomediasinum. Felt to be likely ___ to \npatient's ILD. Increased bowel regimen to prevent straining with \ndefectation that could worsen/exacerbate pneumomediastinum.\n\n#Hypotension - patient frequently hypotensive to 80-90s systolic \nthis admission. Largely asymptomatic. Had some lightheaded ness \nassociated with standing, however felt to be ___ significant \ndeconditioning. Patient taking both digoxin and metoprolol for \nAfib. Reduced dose of metoprolol. Can consider discontinuing \ndigoxin in the future if patient has persistent issues with \nblood pressure and HR was stable this admission.\n\nCHRONIC ISSUES:\n\n#AS s/p AVR, a-fib - Continued home xarelto, digoxin, \nmetoprolol, aspirin \n#HLD - Continued Atorvastatin 40mg qD\n#CAD - Continued ASA 81mg, Metoprolol 25mg XL, Nitro PRN\n#GERD - Continued Omeprazole 20mg qD\n#Anxiety - continued home ativan\n#DEF. - Continued Cyanocobalamin 1000mcg PO qD, Vit D 1000U qD, \nMV\n#Constipation - continued Miralax, Senna, colace. Added \nbisacodyl suppositories PRN.", 'medications_prescribed': ['Bisacodyl ___AILY:PRN constipation \nRX *bisacodyl 10 mg 1 suppository(s) rectally daily:PRN Disp \n#*30 Suppository Refills:*3', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Cyanocobalamin 1000 mcg PO DAILY', 'Digoxin 0.25 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'Lorazepam 0.5 mg PO Q6H:PRN anxiety', 'Multivitamins 1 TAB PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Rivaroxaban 20 mg PO DAILY', 'Senna 8.6 mg PO BID:PRN constipation', 'Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___)', 'Vitamin D 1000 UNIT PO DAILY', 'flaxseed oil 1,000 mg oral DAILY', 'Nitroglycerin SL 0.4 mg SL PRN chest pain', 'PredniSONE 10 mg PO DAILY Duration: 16 Days \nsteroid taper \nRX *prednisone 10 mg see taper tablet(s) by mouth daily Disp \n#*26 Tablet Refills:*0', 'Esbriet (pirfenidone) 801 mg oral Q8H', 'Metoprolol Succinate XL 6.125 mg PO DAILY \nHold for systolic blood pressure less than 90 or heart rate less \nthan 55. \nRX *metoprolol succinate 25 mg 0.25 tablet(s) by mouth daily \nDisp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 77, 'gender': 'F', 'symptoms': 'Abdominal pain', 'medical_history': ['1. Hx of recurrent pancreatitis - pt has had abd pain ___ times \na year since age ___. ___ was admitted w severe bout of \npancreatitis and workup revealed cyst in tail of pancreas but \nall other workup for was neg (including neg HIDA, IGG, Tgl \nlevels). Pt kept having recurrent acute pancreatitis; so \nunderwent distal pancreatectomy and splenectomy in ___ which \nper pt, relived her symptoms greatly. Outp GI is Dr. ___', '2. Multiple recent admissions for various issues but usually for \nabdominal pain', '3. Postural Tachycardia Syndrome - Dx at age ___, followed by\nCardiologist at ___, who tests her for adrenal\ninsufficiency every ___ years w 24 hr urine cortisol levels', "4. Sjogren's syndrome - dx at age ___ when being worked up for \nfatigue. Initially just treated with steroid nasal spray but \nwith worsening of dryness in eyes/mouth started on Plaquenil \nabout ___ years ago. Had short course of prednisone in ___ \nfor a flare", '5. Malabsorption syndrome \x96 etiology uncertain - leading to \niron,\nB12 deficiency. Extensive workup in past including neg duodenal\nbiopsy for Celiac dz', '6. ___ disease', '7. Depression/Anxiety disorder', '8. Hematuria - undergoing work-up currently', '9. Vasculitis (currently tx w/methotrexate; initiated ___', '10. H. pylori (tx w/clarithramycin and amoxicillin, completed \nend of ___'], 'family_history': "Patient's paternal grandfather had pancreatic cancer and DM1. \nPatient's paternal side of family has h/o Lupus, Sjogrens, and \nRA. Father is an alcoholic Patient's mother has asthma and \nsister has bipolar disorder.", 'present_illness': "Patient is a ___ y/o F with a history of chronic pancreatitis, \nSjogrens, vasculitis, POTS presented to ED with sudden onset of \nabdominal pain and vomiting in the setting of chronic abdominal \npain.\n.\nSymptoms of abdominal pain began ~3pm yesterday (___) and \nwere initially releived with tylenol and dilaudid but pain \nincreased in severity. Pt vomitted x2 and dry-heaved numerous \ntimes during the evening and has been unable to keep POs down. \nEmesis consisted of food and bile w/o evidence of blood. \nAbdominal pain is localized to the epigastric and RUQ. Initially \npain was more diffuse as a band above belly button but then \nbecame more localized to mid-epigastric and RUQ with sharp pain \nradiating from the RUQ and a boring sensation to the middle of \nthe back; also had sensations of squeezing. Patient states that \nthe pain is similar to abdominal pain she has had before with \npancreatitis and dehydration. She denies fever but does have \nchills with pain and headache, which are similar to when she's \nbeen dehydrated before. She does acknowledge receiving her \nweekly dose of methotrexate yesterday which was increased to \n25mg; she often experiences nausea with doses. \n.\nAfter repeated vomiting, increased pain and boyfriend noted HR \nof 160, patient was brought to ED. In the ED patient received 2L \nof fluid in addition to 4mg of dilaudid for pain with good \neffect.\n.\nROS was otherwise negative. The pt denied recent unintended \nweight loss, fevers, night sweats, dizziness or vertigo, changes \nin hearing or vision, neck stiffness, lymphadenopathy, \nhematemesis, coffee-ground emesis, dysphagia, odynophagia, \nheartburn, diarrhea, constipation, steatorrhea, melena, \nhematochezia, cough, hemoptysis, wheezing, shortness of breath, \nchest pain, increasing lower extremity swelling, orthpnea, joint \npain.\n.", 'medications': [{'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H: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': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (1000 units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': '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': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fat Emulsion 20%', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 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': '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'TPN', 'status': 'Discontinued', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE-Acetaminophen Elixir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CISplatin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE-Acetaminophen Elixir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 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'valuenum': 276.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.8', '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': '5', 'valuenum': 5.0, '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': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '29.4', 'valuenum': 29.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', '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': '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': '134', 'valuenum': 134.0, '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': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '333', 'valuenum': 333.0, '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': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '319', 'valuenum': 319.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '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': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', '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 70+ is 75 (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': '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': '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': 'TR.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, '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': 'LG.'}, {'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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '26', 'valuenum': 26.0, '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': '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': 10.3, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 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'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, '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': '343', 'valuenum': 343.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, 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None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, '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': '509', 'valuenum': 509.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', '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': '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': 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': '2.3', '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': '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '542', 'valuenum': 542.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.92', 'valuenum': 3.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.050', 'valuenum': 1.05, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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': 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': '2.2', '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '486', 'valuenum': 486.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '482', 'valuenum': 482.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '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': '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': 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': '2.3', '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam: \nVitals: T. , BP , HR , RR sat %RA \nGen: no acute distress, lying in bed resting curled in a ball. \nHEENT: mouth moderately dry appearing, perrla, eomi, anicteric, \nno OP lesions. No lymphadenopathy.\nCV: RRR. NL S1, S2. No murmurs, rubs or gallops appreciated \nLUNGS: CTAB, good air movement, No W/R/C \nABD: + BS, soft, tender in epigastric area, and above the \nperiumbilical area as well as RUQ. neg ___ sign. no \nguarding/rebound. \nEXT: No edema. 2+ DP pulses ___ \nSKIN: No rashes/lesions noted \nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. \nPSYCH: Listens and responds to questions appropriately, pleasant', 'diagnoses': [{'icd_code': '193', 'desc': 'Malignant neoplasm of thyroid gland'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '33912', 'desc': 'Chronic tension type headache'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '3331', 'desc': 'Essential and other specified forms of tremor'}, {'icd_code': '38910', 'desc': 'Sensorineural hearing loss, unspecified'}, {'icd_code': '3879', 'desc': 'Otosclerosis, unspecified'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '70400', 'desc': 'Alopecia, unspecified'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': '78702', 'desc': 'Nausea alone'}, {'icd_code': 'E9331', 'desc': 'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}], 'summary': '___ 01:31AM LACTATE-1.2 K+-4.1\n___ 12:20AM URINE HOURS-RANDOM\n___ 12:20AM URINE GR HOLD-HOLD\n___ 12:20AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 12:20AM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-NEG PH-7.0 LEUK-NEG\n___ 12:20AM URINE ___ BACTERIA-FEW \nYEAST-NONE ___ 12:20AM URINE MUCOUS-FEW\n___ 11:42PM LACTATE-2.4*\n___ 11:00PM GLUCOSE-103 UREA N-10 CREAT-0.7 SODIUM-131* \nCHLORIDE-102 TOTAL CO2-26\n___ 11:00PM estGFR-Using this\n___ 11:00PM ALT(SGPT)-30 AST(SGOT)-156* ALK PHOS-54 TOT \nBILI-0.4\n___ 11:00PM LIPASE-39\n___ 11:00PM ALBUMIN-4.2 CALCIUM-8.8 PHOSPHATE-4.9* \nMAGNESIUM-2.4\n___ 11:00PM WBC-8.5 RBC-3.86* HGB-12.2 HCT-36.0 MCV-93 \nMCH-31.6 MCHC-33.8 RDW-14.1\n___ 11:00PM NEUTS-38.4* LYMPHS-54.3* MONOS-5.5 EOS-1.2 \nBASOS-0.6\n___ 11:00PM PLT COUNT-497*\nPt is a ___ y/o with chronic pancreatitis s/p distal \npancreatectomy, Sjogrens, vasculitis, here with abdominal pain, \nn/v and dehydration. Patient was given IV fluids to rehydrate, \nzofran and ativan for n/v and diluadid for pain with good \neffect. Patient received an ultrasound of the right upper \nquadrant of the abdomen to evaluate for possible biliary \ndisease. This was negative for acute disease. Abdominal/pelvic \nCT did not show any acute process either. Patient was discharged \non home meds after resolution of symptoms.'}}
|
{'final_diagnoses': ['Flare of chronic pancreatitis', 'Vasculitis', 'Postural tachycardia syndrome', "Sjorgen's syndrome", 'Malabsorption syndrome'], 'procedures': ['NA'], 'visit_summary': 'Pt is a ___ y/o with chronic pancreatitis s/p distal \npancreatectomy, Sjogrens, vasculitis, here with abdominal pain, \nn/v and dehydration. Patient was given IV fluids to rehydrate, \nzofran and ativan for n/v and diluadid for pain with good \neffect. Patient received an ultrasound of the right upper \nquadrant of the abdomen to evaluate for possible biliary \ndisease. This was negative for acute disease. Abdominal/pelvic \nCT did not show any acute process either. Patient was discharged \non home meds after resolution of symptoms.', 'medications_prescribed': ['Acetaminophen prn', 'Escitalopram 20 mg daily', 'Fludrocortisone 0.2 mg daily', 'Hydroxychloroquine 200 mg BID', 'Amylase-Lipase-Protease 33,200-10,000- 37,500 unit Capsule, \nDelayed Release(E.C.) 5 Cap PO QIDWMHS', 'Amitriptyline 50 mg qhs', 'Omeprazole 20 mg BID', 'Calcium Carbonate 500 mg QID prn', 'Folic Acid 1 mg daily', 'Docusate Sodium 100 mg BID', 'Prednisone 4 mg daily', 'Alprazolam 1 mg TID prn', 'Betaxolol 10 mg daily', 'Methotrexate 25mg IM/week (last dose was ___ and first time \nreceiving 25mg)']}
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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': 'colonic perforation', 'medical_history': ['1) Asthma (never hospitalized)', '2) Collagenous colitis (on colon biopsy', '3) TMJ with bruxism', '4) S/p left oopherectomy for benign cyst', '5) Positive PPD in childhood, s/p tx with INH for 6months and \nBCG vaccine in medical school.', '6) Post-partum hemmorhage requiring transfusion', '7) Prior depressive episodes'], 'family_history': 'Sister dx\x92d with breast cancer at ___. \nFather died of chondrosarcoma at ___. \nMother with mild hypertension, anxiety, and depression.', 'present_illness': 'This is a ___ year old woman who presents with one day of \nabdominal pain following two colonoscopies. 4 days prior to \nadmission she had a colonoscopy at an outside hospital with a 2 \npolyp resections which was complicated by post-procedural \nbleeding resulting in a nadir hematocrit of 27. She remained in \nthat hospital over the weekend. She did not require transfusion. \nOn ___ she underwent another colonoscop with clip placement, \nthe bleeding stopped and she was discharged. She awoke on \n___ (the day of admission) with right upper quadrant pain. \nShe presented to the outside hospital again where a KUB \ndemonstrated free air under the diaphragm and she was \ntransferred to our emergency room. She was stable, afebrile, \nwith a slightly elevated white count of 12 and a HCT of 32 upon \nadmission. A KUB again demonstrated free air and she was \nadmitted to colorectal surgery for conservative management of \nher perforation.', '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': '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS: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}]}, 'clinical_findings': {'labs': [{'value': '3.44', 'valuenum': 3.44, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, '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': '3.6', 'valuenum': 3.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '7.1', 'valuenum': 7.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.6', 'valuenum': 45.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '301', 'valuenum': 301.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.29', 'valuenum': 0.29, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.57', 'valuenum': 0.57, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.6', 'valuenum': 48.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '77', 'valuenum': 77.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8, . Estimated GFR = 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 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, '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': '138', 'valuenum': 138.0, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'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': '___', 'valuenum': 110.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '12', 'valuenum': 12.0, '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': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.64', 'valuenum': 3.64, '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': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85.1', 'valuenum': 85.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95.8', 'valuenum': 95.8, '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': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 130.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, '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': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.4', 'valuenum': 47.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, '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': '64.5', 'valuenum': 64.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64.0', 'valuenum': 64.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63.7', 'valuenum': 63.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, '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': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '253', 'valuenum': 253.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '3.9', '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': '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': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '73.8', 'valuenum': 73.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen: lying in bed no distress, alert and oriented\nHEENT: anicteric, no trauma\nCV: regular rate, no murmurs, rubs, or gallops\nRESP: clear to auscultation bilaterally\nGI: soft, non distended, non tender\nBack: non tender, no CVA tenderness\nExt: stockings in place, well perfused x4', 'diagnoses': [{'icd_code': 'T8172XA', 'desc': 'Complication of vein following a procedure, not elsewhere classified, initial encounter'}, {'icd_code': 'I81', 'desc': 'Portal vein thrombosis'}, {'icd_code': 'G629', 'desc': 'Polyneuropathy, unspecified'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z96643', 'desc': 'Presence of artificial hip joint, 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': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}], 'summary': '___ 07:45AM BLOOD WBC-8.0 RBC-2.90* Hgb-9.1* Hct-28.2* \nMCV-97 MCH-31.2 MCHC-32.1 RDW-12.9 Plt ___\n___ 12:47PM BLOOD WBC-12.7* RBC-3.24* Hgb-10.2* Hct-32.1* \nMCV-99*# MCH-31.5 MCHC-31.9 RDW-13.7 Plt ___\n___ 07:45AM BLOOD Glucose-105* UreaN-8 Creat-0.8 Na-142 \nK-3.5 Cl-106 HCO3-30 AnGap-10\n___ 12:47PM BLOOD Glucose-98 UreaN-14 Creat-0.9 Na-137 \nK-GREATER TH Cl-99 HCO3-19*\n___ 01:13PM BLOOD Lactate-1.2 Na-143 K-3.___r ___ presented to ___ on ___ with a colonic \nmicroperforation. She was admited to the colorectal surgery \nservice for conservative management. Her hospital course by \nissue is described below.\nNeuro: The patient had mild abdominal pain on admission. \nNarcotics were not administered as patient did not require them \nand we wished to preserve any acute changes in her abdominal \nexam. Her home psychiatric medications were restarted \nimmediately. She required a one time dose of lorazepam for sleep \non HD#2. \nCV: She remained stable from a cardiovascular standpoint. Her \nadmission HCT was 32 and on HD#1 it was 28. She did not require \ntransfusion during this hospitalization and she was \nhemodynamically stable throughout. \nPulm: She had no acute pulmonary issues during this admission. \nGI: On admission her KUB demonstrated free air beneath the \ndiaphragm presumably from a microperforation secondary to her \nrecent colonoscopes. She was made NPO, given maintenance IV \nfluids for hydration, and serial abdominal exams were performed. \nShe did not develop any peritoneal signs. After 24 hours of \ncomplete bowel rest she was started on a clear liquid diet and \nher IV hydration was stopped. She tolerated the diet and her \nabdomen remained benign. On hospital day #2 she was started on a \nlow residue regular diet which she tolerated without pain. Her \nexam remained benign and she was discharged.\nGU: The patient had a history of assymptomatic bacteruria. She \ndid not demonstrate any symptoms of UTI and voided freely \nthroughout the admission.\nID: She was initially started on cipro/flagyl IV therapy for her \ncolonic perforation. Her white count was initially elevated to \n12 and dropped to 8 on HD#2. She remained afebrile and was \ntransitioned to PO antibiotics and discharged to complete a 10 \nday course. \nHeme: Her anemia was as above. She declined subcutaneous heparin \nand DVT prophylaxis was performed ___. \n\nOn ___, the patient was discharged to home. At \ndischarge, she was tolerating a regular diet, passing flatus, \nstooling, voiding, and ambulating independently. She will \nfollow-up as needed. This information was communicated to the \npatient directly prior to discharge.'}}
|
{'final_diagnoses': ['microperforation following colonscopy'], 'procedures': ['none'], 'visit_summary': 'Neuro: The patient had mild abdominal pain on admission. \nNarcotics were not administered as patient did not require them \nand we wished to preserve any acute changes in her abdominal \nexam. Her home psychiatric medications were restarted \nimmediately. She required a one time dose of lorazepam for sleep \non HD#2. \nCV: She remained stable from a cardiovascular standpoint. Her \nadmission HCT was 32 and on HD#1 it was 28. She did not require \ntransfusion during this hospitalization and she was \nhemodynamically stable throughout. \nPulm: She had no acute pulmonary issues during this admission. \nGI: On admission her KUB demonstrated free air beneath the \ndiaphragm presumably from a microperforation secondary to her \nrecent colonoscopes. She was made NPO, given maintenance IV \nfluids for hydration, and serial abdominal exams were performed. \nShe did not develop any peritoneal signs. After 24 hours of \ncomplete bowel rest she was started on a clear liquid diet and \nher IV hydration was stopped. She tolerated the diet and her \nabdomen remained benign. On hospital day #2 she was started on a \nlow residue regular diet which she tolerated without pain. Her \nexam remained benign and she was discharged.\nGU: The patient had a history of assymptomatic bacteruria. She \ndid not demonstrate any symptoms of UTI and voided freely \nthroughout the admission.\nID: She was initially started on cipro/flagyl IV therapy for her \ncolonic perforation. Her white count was initially elevated to \n12 and dropped to 8 on HD#2. She remained afebrile and was \ntransitioned to PO antibiotics and discharged to complete a 10 \nday course. \nHeme: Her anemia was as above. She declined subcutaneous heparin \nand DVT prophylaxis was performed ___. \n\nOn ___, the patient was discharged to home. At \ndischarge, she was tolerating a regular diet, passing flatus, \nstooling, voiding, and ambulating independently. She will \nfollow-up as needed. This information was communicated to the \npatient directly prior to discharge.', 'medications_prescribed': ['1. LaMOTrigine 100 mg PO BID', '2. TraZODone 100 mg PO HS:PRN sleep', '3. Ciprofloxacin HCl 500 mg PO Q12H \nRX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a \nday Disp #*17 Tablet Refills:*0', '4. Hydrochlorothiazide 25 mg PO DAILY', '5. Aripiprazole 2.5 mg PO DAILY', '6. meloxicam 15 mg oral BID', '7. simvastatin 20 mg oral once daily', '8. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H \ndo not drink alcohol with medication. consume with small amount \nof food \nRX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth three \ntimes a day 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': 73, 'gender': 'M', 'symptoms': 'back pain', 'medical_history': ['Right hip early degenerative joint disease', 'Degenerative labral tear', 'Insomnia', 'Chronic LBP'], 'family_history': 'Brother recently died from colon CA at age ___. Father passed \naway from metastatic CA that started "in the throat." Mom is \nstill alive at ___ and has CAD. Her sister has HTN. No fam Hx of \nDM.', 'present_illness': '___ year old woman with right sided L4-5 disc herniation and \nassociated chronic back pain presents with back pain and \nparesthesias and weakness in the L5 distribution. She has only \nbeen partially responsive to steroid injections in the past. \nRecent MRI shows slight increase in the size of the disc bulge. \nNo bowel/bladder retention or incontinence. Of note she has had \nmultiple ED visits for back pain, but has not been able to make \nappropriate appointments with pain specialty clinic or spinal \nsurgeons to consider surgical intervention. \nIn the ED, initial vitals were: 98.7 93 126/84 18 100% and ___ \npain. No labs or imaging was pursued. She received ketorolac \n30mg, morphine IV 4mg x3, and benadryl 25mg x2 (itching after \nmorphine). She was seen by the spinal consult team who felt she \nwould likely benefit from repeat steroid injection, but not at \nthis time. She was given the choice to go home, but chose \nadmission for pain control. Vitals prior to transfer: 97.8 75 \n125/83 16 97% RA. \nUpon arrival to the floor, pt continues to endorse ___ pain \nradiating down the leg', 'medications': [{'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', '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': 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 via patient discharge', 'route': 'SC', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H: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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': '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}]}, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, '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': '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', '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': '28.4', 'valuenum': 28.4, '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': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89.6', 'valuenum': 89.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '281', 'valuenum': 281.0, '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': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1000', 'valuenum': 1000.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': 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': '1.019', 'valuenum': 1.019, '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': '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': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, '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': '89', 'valuenum': 89.0, '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': 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': '3.05', 'valuenum': 3.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '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': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS - Temp 97.6F, BP 112/82, HR 82, R 20, O2-sat 100% RA \nGENERAL - Well-developed, well-nourished. NAD, appears \ncomfortable, talkative, appropriate \nHEENT - NC/AT, sclerae anicteric, MMM \nHEART - RRR, nl S1-S2, no MRG \nLUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored, no \naccessory muscle use \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact. Muscle strength \n___ in LLE, ___ in RLE ___ pain. Sensation intact in ___ b/l.', 'diagnoses': [{'icd_code': '00845', 'desc': 'Intestinal infection due to Clostridium difficile'}, {'icd_code': '99769', 'desc': 'Other amputation stump 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'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '44020', 'desc': 'Atherosclerosis of native arteries of the extremities, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': '___ 06:20AM BLOOD ___ PTT-34.1 ___ year old woman with right sided L4-5 disc herniation presents \nwith exacerbation of chronic low back pain with worsening right \nlower extremity paresthesias and weakness.\n# Low back pain: Secondary to known disc herniation which has \nincreased in the interim (from ___ to ___ and is \ncausing right L5 radicular paresthesias and weakness. No \nclinical signs/symptoms of cauda equina or cord compression. She \nhas had only partial relief with steroid injections in the past \nand was very resistant to any further steroid injection trials. \nAppreciate quick response by spine team who performed \nmicrodiscectomy ___. Gabapentin was increased to 800mg TID. \nShe had some muscular soreness post-op, but Flexeril was added \nto po regimen. On POD 1, pt was able to walk with a walker and \nfelt to be safe to go home by ___. She has follow up scheduled \nwith her PCP, ___, and her spine surgeon. \n \n# tobacco use: Nicotine patch and gum PRN were used to reduce \ncravings while inpatient\n\n# insomnia: Per pt, ___ pain. Continued home Seroquel PRN. \n \n# GERD: Continued home PPI'}}
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{'final_diagnoses': ['R L45 disc herniation'], 'procedures': ['R L4-5 microdiscectomy (___)'], 'visit_summary': '# Low back pain: Secondary to known disc herniation which has \nincreased in the interim (from ___ to ___ and is \ncausing right L5 radicular paresthesias and weakness. No \nclinical signs/symptoms of cauda equina or cord compression. She \nhas had only partial relief with steroid injections in the past \nand was very resistant to any further steroid injection trials. \nAppreciate quick response by spine team who performed \nmicrodiscectomy ___. Gabapentin was increased to 800mg TID. \nShe had some muscular soreness post-op, but Flexeril was added \nto po regimen. On POD 1, pt was able to walk with a walker and \nfelt to be safe to go home by ___. She has follow up scheduled \nwith her PCP, ___, and her spine surgeon. \n \n# tobacco use: Nicotine patch and gum PRN were used to reduce \ncravings while inpatient\n\n# insomnia: Per pt, ___ pain. Continued home Seroquel PRN. \n \n# GERD: Continued home PPI', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H \nRX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2 \ntablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0', 'Amitriptyline 50 mg PO HS', 'Gabapentin 800 mg PO Q8H \nRX *gabapentin [Neurontin] 800 mg 1 tablet(s) by mouth three \ntimes a day Disp #*90 Tablet Refills:*0', 'Omeprazole 20 mg PO DAILY', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain not \nrelieved by acetaminopen, cyclobenziprine \nRX *oxycodone 5 mg 1 tablet(s) by mouth q6 hours Disp #*15 \nTablet Refills:*0', 'Quetiapine Fumarate 25 mg PO HS:PRN insomnia', 'Cyclobenzaprine 10 mg PO TID:PRN back pain \nRX *cyclobenzaprine 10 mg 1 tablet(s) by mouth three times a day \nDisp #*15 Tablet Refills:*0', 'Ibuprofen 600 mg PO Q8H:PRN pain \nRX *ibuprofen 600 mg 1 tablet(s) by mouth three times a day Disp \n#*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': 55, 'gender': 'F', 'symptoms': 'chest pain and shortness of breath', 'medical_history': ['1. CARDIAC RISK FACTORS: Hypertension', '2. CARDIAC HISTORY: \n-CABG: N/A\n-PERCUTANEOUS CORONARY INTERVENTIONS: N/A\n-PACING/ICD: PPM placed ___ for 2nd degree AV block', '3. OTHER PAST MEDICAL HISTORY: \n-Hypertension', '-End stage renal failure on hemodialysis at ___ \na/p left AV fistula', '-Mobitz type 1 second-degree AV block - Pacemaker placed ___'], 'family_history': 'Mother: deceased, diabetes ___ and coronary artery disease \nFather: deceased, lung cancer \nSister: diabetes ___\nSon: prostate cancer', 'present_illness': "___ with ESRD on HD ___, Alzheimer's Dementia, HTN and \n2nd degree AV block s/p PPM who presented from ___ clinic with \nchest pain and shortness of breath. Patient cannot recall \nincident, but per her son who accompanies her today, patient \ndeveloped chest pain at ___ clinic before her HD and was referred \nto the ED. \n\nIn the ED, initial vitals were 97.6 74 190/55 31 93%. She \nreceived 1 sl nitro and was started on a nitro gtt with \nimprovement in her BP and dyspnea. Labs notable for BNP 34,000, \nTnT 0.09, nl electrolytes, Hct 32.8. CXR showed evidence of \npulmonary edema. She was admitted to ___ for further \nmanagement.\n\nOn the floor, patient was started on HD at the bedside and \nnitroglycerin drip was weaned off. She denied chest pain, SOB.\n\nCardiac review of systems is notable for absence of dyspnea on \nexertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, \npalpitations, syncope or presyncope.", 'medications': [{'medication': 'Ondansetron', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Loratadine', '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': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', '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', 'frequency': 'Q3H: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': '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Losartan Potassium', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Aluminum-Magnesium Hydrox.-Simethicone', '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': 'Expired', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '26', 'valuenum': 26.0, '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': '0.6', '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': '___', '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, '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': '34.4', 'valuenum': 34.4, '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': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '33.7', 'valuenum': 33.7, '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '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': '8.8', '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': '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': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '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', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, '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': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.86', 'valuenum': 2.86, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', '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': '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': '10', 'valuenum': 10.0, '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': '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': '33.6', 'valuenum': 33.6, '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.2', 'valuenum': 48.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVS: T 97.7 165/54 60 20 100% 2L\nWeight 65kg \nGENERAL: WDWN elderly female in NAD. Oriented x3. Mood, affect \nappropriate. Undergoing HD\nHEENT: NCAT. NC in place. Sclera anicteric. PERRL, EOMI. \nNECK: no JVP elevation at 90 degrees, RR, normal S1, S2. ___ \nsystolic murmur heard throughout precordium. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. Clear to auscultation \nanteriorly\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. DP 2+ ___ 2+ \n.\n\nDISCHARGE PHYSICAL EXAMINATION: \nVS: Tm 99.3 Tc 98.8 125-127/51-62 58-59 ___ 96-97% RA\nGENERAL: WDWN elderly female, breathing deeply through mouth. \nEasily arousable, oriented to person and place, not year\nHEENT: NCAT. \nNECK: no JVP elevation at 90 degrees, RR, normal S1, S2. ___ \nsystolic murmur heard throughout precordium. No S3 or S4. \nLUNGS: clear to auscultation \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. DP 2+ ___ 2+ \n', 'diagnoses': [{'icd_code': 'M162', 'desc': 'Bilateral osteoarthritis resulting from hip dysplasia'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'M170', 'desc': 'Bilateral primary osteoarthritis of knee'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'F17200', 'desc': 'Nicotine dependence, unspecified, uncomplicated'}, {'icd_code': 'M545', 'desc': 'Low back pain'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}], 'summary': "LABS:\n----------\n___ 02:30PM CK-MB-2 cTropnT-0.11*\n___ 07:46AM GLUCOSE-138* UREA N-31* CREAT-6.3*# \nSODIUM-140 POTASSIUM-4.3 CHLORIDE-103 TOTAL CO2-24 ANION GAP-17\n___ 07:46AM cTropnT-0.09* ___\n___ 07:46AM CALCIUM-9.5 PHOSPHATE-4.1 MAGNESIUM-1.8\n___ 07:46AM WBC-4.3 RBC-3.46* HGB-10.6* HCT-32.8* MCV-95 \nMCH-30.5 MCHC-32.2 RDW-15.7*\n___ 07:46AM NEUTS-66.9 LYMPHS-15.0* MONOS-7.9 EOS-9.6* \nBASOS-0.6\n___ 07:46AM PLT COUNT-133*\n___ 07:43AM LACTATE-1.4\n\nIMAGING/STUDIES:\n-------------------\nECG ___\nAtrial paced rhythm with baseline artifact. Probable left \nventricular \nhypertrophy. Extensive pronounced repolarization abnormalities \nconsistent with left ventricular hypertrophy strain pattern. \nCompared to the previous tracing of ___ marked \nrepolarization abnormalities are unchanged. \n.\nCXR ___\nCHEST, SINGLE AP PORTABLE VIEW. \nA dual-lead pacemaker is in place, with lead tips over right \natrium and right ventricle. There are low inspiratory volumes. \nAllowing for this, there does appear to be pulmonary vascular \nplethora and interstitial edema. Possible minimal blunting of \nthe right costophrenic angle. There is bibasilar atelectasis, \nwith subtle patchy opacity at both bases. Mediastinal contours \nare unchanged compared with ___, with probable mild \ncardiomegaly and slight unfolding of the aorta. \nSubtle tapered appearance of both distal clavicles is noted, \nwithout \naggressive features and unchanged compared with ___. \nIMPRESSION: \n1. Probable CHF, even allowing for low inspiratory volumes. \n2. Bibasilar atelectasis. The possibility of early pneumonic \ninfiltrate \nwould be difficult to exclude in this setting. \n .\nRight ankle x-ray ___\nRIGHT ANKLE, THREE VIEWS. \nThere is diffuse osteopenia. No lucent or sclerotic fracture \nline or \ndisplaced fracture is detected about the ankle. The mortise is \ncongruent. Some subchondral lucency along the medial talar dome \ncould reflect an old talar dome OCD (osteochondritis dissecans). \n There is soft tissue swelling about the ankle, more prominent \nlaterally. A small ossific fragment (3.4 mm) is seen in the \nsoft tissues along the lateral midfoot. No obvious donor site \nis identified and this does not clearly represent a peroneal \nossicle. There are degenerative changes of the tibiotalar joint \nwith marginal spurring along the tibia, osteophytic spurring \nalong the dorsum of the midfoot with some overlying soft tissue \nprominence, and calcaneal enthesophytic spurring. \n \nIMPRESSION: \n \n1. Osteopenia and soft tissue swelling. \n2. No obvious acute fracture. If symptoms persist, followup \nfilms in ___ days could help to assess for resorption about an \noccult fracture, as \nosteopenia can limit sensitivity for fracture detection. \n3. Degenerative changes. \n4. Suspected old medial talar dome OCD. \n\nTransthoracic Echo ___\nResults Measurements Normal Range \nLeft Atrium - Long Axis Dimension: *4.3 cm <= 4.0 cm \nLeft Atrium - Four Chamber Length: 5.1 cm <= 5.2 cm \nLeft Atrium - Peak Pulm Vein S: 0.6 m/s \nLeft Atrium - Peak Pulm Vein D: 0.6 m/s \nLeft Atrium - Peak Pulm Vein A: 0.3 m/s < 0.4 m/s \nRight Atrium - Four Chamber Length: 4.8 cm <= 5.0 cm \nLeft Ventricle - Septal Wall Thickness: *1.3 cm 0.6 - 1.1 cm \nLeft Ventricle - Inferolateral Thickness: *1.3 cm 0.6 - 1.1 cm \n \nLeft Ventricle - Diastolic Dimension: 3.4 cm <= 5.6 cm \nLeft Ventricle - Systolic Dimension: 2.1 cm \nLeft Ventricle - Fractional Shortening: 0.38 >= 0.29 \nLeft Ventricle - Ejection Fraction: >= 70% >= 55% \nLeft Ventricle - Lateral Peak E': *0.06 m/s > 0.08 m/s \nLeft Ventricle - Septal Peak E': *0.06 m/s > 0.08 m/s \nLeft Ventricle - Ratio E/E': 13 < 15 \nAorta - Sinus Level: 3.4 cm <= 3.6 cm \nAorta - Ascending: *3.8 cm <= 3.4 cm \nAorta - Arch: 2.9 cm <= 3.0 cm \nAorta - Descending Thoracic: 1.9 cm <= 2.5 cm \nAortic Valve - Peak Velocity: 1.4 m/sec <= 2.0 m/sec \nAortic Valve - LVOT diam: 2.0 cm \nMitral Valve - E Wave: 0.8 m/sec \nMitral Valve - A Wave: 0.7 m/sec \nMitral Valve - E/A ratio: 1.14 \nMitral Valve - E Wave deceleration time: *469 ms 140-250 ms \nTR Gradient (+ RA = PASP): *39 mm Hg <= 25 mm Hg \nPulmonic Valve - Peak Velocity: 0.9 m/sec <= 1.5 m/sec \n \nFindings \nThis study was compared to the prior study of ___. \nLEFT ATRIUM: Mild ___. \n\nRIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or \npacing wire is seen in the RA and extending into the RV. Dynamic \ninteratrial septum. \n\nLEFT VENTRICLE: Mild symmetric LVH with normal cavity size and \nregional/global systolic function (LVEF>55%). No resting LVOT \ngradient. \n\nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Normal aortic diameter at the sinus level. Focal \ncalcifications in aortic root. Mildly dilated ascending aorta. \nNormal aortic arch diameter. Normal descending aorta diameter. \nNo 2D or Doppler evidence of distal arch coarctation. \n\nAORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. \nTrace AR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. \nModerate mitral annular calcification. Mild thickening of mitral \nvalve chordae. Calcified tips of papillary muscles. Trivial MR. \n___ inflow pattern c/w impaired relaxation. \n\nTRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild \n[1+] TR. Moderate PA systolic hypertension. \n\nPULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. \nNo PS. Physiologic PR. \n\nPERICARDIUM: No pericardial effusion. \nConclusions \nThe left atrium is mildly dilated. There is mild symmetric left \nventricular hypertrophy with normal cavity size and \nregional/global systolic function (LVEF>70%). Right ventricular \nchamber size and free wall motion are normal. The ascending \naorta is mildly dilated. The aortic valve leaflets (3) are \nmildly thickened but aortic stenosis is not present. Trace \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. Trivial \nmitral regurgitation is seen. The left ventricular inflow \npattern suggests impaired relaxation. The tricuspid valve \nleaflets are mildly thickened. There is moderate pulmonary \nartery systolic hypertension. There is no pericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \npreserved global and regional biventricular systolic function \nand impaired LV relaxation. Mildly dilated ascending aorta. \nModerate pulmonary hypertension.\n___ with ESRD on HD, HTN, 2nd degree AV block s/p PPM who \npresented with hypoxia and hypertension from ___ clinic. \nComplicated by obvious intermittent dyspnea/tachypnea of unclear \netiology.\n.\n#Hypertensive emergency: Patient presented from HD center with \nhypoxia and evidence of flash pulmonary edema on CXR, presumably \nfrom SBP in the 190s. Started on nitro gtt in ED, was weaned off \nduring bedside HD ___. SBP intermittently elevated to 180. Home \nhydralazine was increased to 20mg TID and carvedilol 6.25mg BID \nwas started with improved BP control SBP 120s-130s. She was \ncontinued on home amlodipine and imdur. Also of note, the \npatient was found to become increasingly hypertensive 24 hours \nprior to each dialysis session, which resolved after HD.\n.\n#Labored breathing: Pt noted to appear intermittently dyspneic, \ntaking deep breaths through her mouth. Patient denied dyspnea \nwhen asked. O2 sats on one occasion 89-91% on room air prior to \ndialysis which improved when she sat up and was encouraged to \nbreath through her mouth, but otherwise had normal O2 sats on \nroom air. BP remained within normal limits during episode with \nunchanged pulmonary exam. Recommended incentive spirometry and \nout of bed to chair. Speech and swallow evaluated the patient at \nbedside and determined that she was not at risk for aspiration. \nThere was no radiographic, clinic, or laboratory evidence for \npneumonia. A repeat ECHO was unchanged from prior. PE was felt \nto be less likely given intermittent nature of symptoms and \nclose correlation of hypoxia with pulmonary edema on imaging. \nAppearance of labored breathing may be due to a central process \nversus anxiety, as patient was intermittently confused \nthroughout admission which appeared to cause her some stress.\n.\n# Alzheimer's dementia/Altered mental status: Waxing waning \nmental status consistent with delerium in the setting of \ninpatient hospitalization. The patient has progressing dementia \nat baseline and is typically oriented to person and place. \nHowever, the patient was noted to be agitated especially \novernight. She was very redirectable. TSH, RPR were negative. \nNo localizing infectious symptoms, fevers or leukocytosis to \nsuggest infection. Electrolytes appear to be at baseline in the \nsetting of ESRD. No new medications other than 1 time dose of \nzyprexa given overnight ___, without much effect. Continued \nhome rivastigmine. She was discharged to rehab at her baseline \nwith plan to assess for long term placement in the future.\n.\n# Chest pain: Patient reported intermittent chest pain, likely \nMSK etiology given reproducibility on palpation. Possible minor \ntrauma related to fall at home prior to admission. No evidence \nof fracture on chest x ray. SBP 140s during symptoms, satting \nwell on room air and pulmonary exam unchanged, making recurrent \nflash pulmonary edema unlikely. EKG unchanged, no relief w/ SL \nnitro making cardiac etiology unlikely as well. It was treated \nwith acetaminophen prn and resolved by discharge. \n.\n# Ankle pain: Daughter reported that patient had unwitnessed \nmechanical fall at home on 1 day prior to hospitalization. In \nthe hospital, she was unable to bear weight on right leg, + \npoint tenderness to palpation of right lateral malleolus. Plain \nfilm negative for fracture, ___ recommended dc to ___ \nrehab.\n.\n#Hypoxia: As above, likely from flash pulmonary edema in the \nsetting of hypertensive emergency. BNP elevated to 34,000 from \nprior value 19K in ___. HD ___ removed 1.9L fluid, \nsubsequently satting 96-100% RA. Intermittent sats 89-90% as \nabove. Pt had multiple UF/HD sessions this admission with marked \nimprovement in pulmonary edema on CXR prior to discharge.\n.\n#Troponin elevation: TnT of 0.09 in the ED, lowest recorded \nvalue in our system. Above normal range, likely due to ESRD. \nRepeat troponin of 0.11 was not significantly increased and \nstill lower than baseline. \n.\n#ESRD on HD: Underwent HD at the bedside ___ and ___ with \nremoval of 1.9L and 2.5L of fluid, respectively. Continued with \nregular ___ HD schedule during admission."}}
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{'final_diagnoses': ['Acute on chronic diastolic heart failure', 'Hypertension', 'Musculoskeletal chest pain', 'End stage renal disease'], 'procedures': ['None'], 'visit_summary': "___ with ESRD on HD, HTN, 2nd degree AV block s/p PPM who \npresented with hypoxia and hypertension from ___ clinic. \nComplicated by obvious intermittent dyspnea/tachypnea of unclear \netiology.\n.\n#Hypertensive emergency: Patient presented from HD center with \nhypoxia and evidence of flash pulmonary edema on CXR, presumably \nfrom SBP in the 190s. Started on nitro gtt in ED, was weaned off \nduring bedside HD ___. SBP intermittently elevated to 180. Home \nhydralazine was increased to 20mg TID and carvedilol 6.25mg BID \nwas started with improved BP control SBP 120s-130s. She was \ncontinued on home amlodipine and imdur. Also of note, the \npatient was found to become increasingly hypertensive 24 hours \nprior to each dialysis session, which resolved after HD.\n.\n#Labored breathing: Pt noted to appear intermittently dyspneic, \ntaking deep breaths through her mouth. Patient denied dyspnea \nwhen asked. O2 sats on one occasion 89-91% on room air prior to \ndialysis which improved when she sat up and was encouraged to \nbreath through her mouth, but otherwise had normal O2 sats on \nroom air. BP remained within normal limits during episode with \nunchanged pulmonary exam. Recommended incentive spirometry and \nout of bed to chair. Speech and swallow evaluated the patient at \nbedside and determined that she was not at risk for aspiration. \nThere was no radiographic, clinic, or laboratory evidence for \npneumonia. A repeat ECHO was unchanged from prior. PE was felt \nto be less likely given intermittent nature of symptoms and \nclose correlation of hypoxia with pulmonary edema on imaging. \nAppearance of labored breathing may be due to a central process \nversus anxiety, as patient was intermittently confused \nthroughout admission which appeared to cause her some stress.\n.\n# Alzheimer's dementia/Altered mental status: Waxing waning \nmental status consistent with delerium in the setting of \ninpatient hospitalization. The patient has progressing dementia \nat baseline and is typically oriented to person and place. \nHowever, the patient was noted to be agitated especially \novernight. She was very redirectable. TSH, RPR were negative. \nNo localizing infectious symptoms, fevers or leukocytosis to \nsuggest infection. Electrolytes appear to be at baseline in the \nsetting of ESRD. No new medications other than 1 time dose of \nzyprexa given overnight ___, without much effect. Continued \nhome rivastigmine. She was discharged to rehab at her baseline \nwith plan to assess for long term placement in the future.\n.\n# Chest pain: Patient reported intermittent chest pain, likely \nMSK etiology given reproducibility on palpation. Possible minor \ntrauma related to fall at home prior to admission. No evidence \nof fracture on chest x ray. SBP 140s during symptoms, satting \nwell on room air and pulmonary exam unchanged, making recurrent \nflash pulmonary edema unlikely. EKG unchanged, no relief w/ SL \nnitro making cardiac etiology unlikely as well. It was treated \nwith acetaminophen prn and resolved by discharge. \n.\n# Ankle pain: Daughter reported that patient had unwitnessed \nmechanical fall at home on 1 day prior to hospitalization. In \nthe hospital, she was unable to bear weight on right leg, + \npoint tenderness to palpation of right lateral malleolus. Plain \nfilm negative for fracture, ___ recommended dc to ___ \nrehab.\n.\n#Hypoxia: As above, likely from flash pulmonary edema in the \nsetting of hypertensive emergency. BNP elevated to 34,000 from \nprior value 19K in ___. HD ___ removed 1.9L fluid, \nsubsequently satting 96-100% RA. Intermittent sats 89-90% as \nabove. Pt had multiple UF/HD sessions this admission with marked \nimprovement in pulmonary edema on CXR prior to discharge.\n.\n#Troponin elevation: TnT of 0.09 in the ED, lowest recorded \nvalue in our system. Above normal range, likely due to ESRD. \nRepeat troponin of 0.11 was not significantly increased and \nstill lower than baseline. \n.\n#ESRD on HD: Underwent HD at the bedside ___ and ___ with \nremoval of 1.9L and 2.5L of fluid, respectively. Continued with \nregular ___ HD schedule during admission.", 'medications_prescribed': ['1. Aspirin 81 mg PO DAILY', '2. Cinacalcet 30 mg PO DAILY', '3. Docusate Sodium 100 mg PO BID', '4. HydrALAzine 20 mg PO Q8H\nRX *hydralazine 10 mg 2 tablet(s) by mouth Every 8 hours Disp \n#*180 Tablet Refills:*0', '5. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY', '6. Polyethylene Glycol 17 g PO DAILY', '7. rivastigmine *NF* 6 mg Oral BID', '8. Senna 1 TAB PO BID:PRN constipation', '9. Omeprazole 20 mg PO DAILY', '10. Amlodipine 10 mg PO DAILY', '11. Carvedilol 6.25 mg PO BID\nRX *carvedilol 6.25 mg 1 tablet(s) by mouth Twice daily Disp \n#*60 Tablet Refills:*0', '12. Acetaminophen 1000 mg PO Q8H pain']}
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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': 'head trauma', 'medical_history': ['None'], 'family_history': 'N/C', 'present_illness': '___ w no significant PMH xfer from OSH with skull fx, TBI\ns/p collision with goal post while playing soccer. Patient was\nrunning during a soccer game and struck the posterior aspect of\nhis head on the metal soccer goal post. Patient has no\nrecollection of head strike but according to friends who\nwitnessed event, patient fell to ground and lost consciousness\nfor period of "few minutes." Patient was taken by ambulance to\nOSH where he an occipital scalp laceration was stapled and CT\nimages of head and c-spine obtained. CT revealed L temporal bone\nfx w overlying scalp hematoma w subcutaneous emphysema, R\ncerebellar SDH. Patient was A&Ox3 and neurologically intact at\ntime of xfer to ___ for neurosurgical evaluation.\n\nUpon neurosurgical evaluation, patient complains of mild L\nposterior auricular /occipital pain but is without other\ncomplaint. Denies headache, dizziness, visual disturbance,\nhearing loss, difficulty speaking, tingling, numbness or\nweakness.', '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': 'Morphine Sulfate', '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': 'Ranitidine', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'RiTONAvir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atazanavir', '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': 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': '8.0', 'valuenum': 8.0, '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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': '>1.050*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', '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': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, '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': '43.2', 'valuenum': 43.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, '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': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, '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': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\nO: T: 98.3 BP: 106/63 HR: 75 R 18 O2Sats 96RA\nGen: WD/WN, comfortable, NAD.\nHEENT: \n+posterior auricular hematoma extending posterior to occiput; no\ncranial step-offs or defects\nPupils: 3-2mm B/L EOMs intact\nNeck: Supple.\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension and repetition.\nNo dysarthria or paraphasic errors.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 3 to\n2mm bilaterally. \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, rapid alternating\nmovements\n\nOn Discharge:\nAAO x 3\nPERRL\nNo pronator drift\nFull strength throughout\nSensation intact to light touch', 'diagnoses': [{'icd_code': '5368', 'desc': 'Dyspepsia and other specified disorders of function of stomach'}, {'icd_code': '7821', 'desc': 'Rash and other nonspecific skin eruption'}, {'icd_code': '7824', 'desc': 'Jaundice, unspecified, not of newborn'}, {'icd_code': 'V08', 'desc': 'Asymptomatic human immunodeficiency virus [HIV] infection status'}, {'icd_code': '2774', 'desc': 'Disorders of bilirubin excretion'}], 'summary': "PORTABLE HEAD CT W/O CONTRAST ___\n1. Stable small posterior right temporal intraparenchymal \nhematoma. \n2. Mild increase in size of right temporal intraparenchymal \nhemorrhage with surrounding edema, without associated mass \neffect or shift of midline \nstructures. \n3. Stable left occipital and temporal region soft tissue \nhematoma with new overlying staples. \n4. Previously seen nondisplaced mastoid fracture is not fully \nevaluated on this scan given absence of bone reconstruction \nimaging. No displaced fracture fragment seen. \n\n___ CT head without contrast\n\n1. Stable right temporal intraparenchymal contusions. \n \n2. Stable nondisplaced left mastoid fracture with opacification \nof the middle ear cavity. \n \n3. Unchanged appearance of left temporal and occipital soft \ntissue hematoma.\n___ y/o M s/p head trauma presents with R temporal contusion and \ntemporal bone fracture. He was admitted to neurosurgery for \nclose observation. He was intact on examination. On ___, \npatient remained intact. Dry blood was seen in patient's L ear, \nno active drainage was seen and a gauze was placed to monitor \nfor drainage. A repeat head CT was performed and showed slight \nincrease in R temporal contusion. He was stable and transferred \nto the floor. His diet was increased. \n\nENT was asked to see the patient due to his left \nmastoid/temporal bone fracture. They recommended that he use \nCiprodex twice daily due to an external auditory canal \nlaceration. He was advised to follow sinus precautions and \nfollow up with Dr. ___ in four weeks for re-evaluation. \nDue to his loss of consciousness, the patient was seen by \nOccupational Therapy for a cognitive evaluation. Their \nrecommendation was that Mr. ___ see Dr. ___ \nCognitive ___. \n\nAt the time of discharge, Mr. ___ was afebrile, \nhemodynamically and neurologically stable. The patient will \ncontinue on Keppra for a total of seven days for seizure \nprophylaxis. He was ambulating independently and tolerating a \nregular diet well. Discharge instructions and applicable \nprescriptions were provided."}}
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{'final_diagnoses': ['Small posterior right temporal intraparenchymal hematoma', 'Right temporal intraparenchymal hematoma', 'Nondisplaced left mastoid fracture', 'Left temoral and occipital soft tissue hematomas', 'Left external auditory canal laceration', 'Traumatic brain injury'], 'procedures': ['None'], 'visit_summary': "___ y/o M s/p head trauma presents with R temporal contusion and \ntemporal bone fracture. He was admitted to neurosurgery for \nclose observation. He was intact on examination. On ___, \npatient remained intact. Dry blood was seen in patient's L ear, \nno active drainage was seen and a gauze was placed to monitor \nfor drainage. A repeat head CT was performed and showed slight \nincrease in R temporal contusion. He was stable and transferred \nto the floor. His diet was increased. \n\nENT was asked to see the patient due to his left \nmastoid/temporal bone fracture. They recommended that he use \nCiprodex twice daily due to an external auditory canal \nlaceration. He was advised to follow sinus precautions and \nfollow up with Dr. ___ in four weeks for re-evaluation. \nDue to his loss of consciousness, the patient was seen by \nOccupational Therapy for a cognitive evaluation. Their \nrecommendation was that Mr. ___ see Dr. ___ \nCognitive ___. \n\nAt the time of discharge, Mr. ___ was afebrile, \nhemodynamically and neurologically stable. The patient will \ncontinue on Keppra for a total of seven days for seizure \nprophylaxis. He was ambulating independently and tolerating a \nregular diet well. Discharge instructions and applicable \nprescriptions were provided.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Docusate Sodium 100 mg PO BID', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*45 Tablet Refills:*0', 'LeVETiracetam 500 mg PO BID RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0', 'Ciprofloxacin 0.3% Ophth Soln 4 DROPS LEFT EAR BID Duration: 10 Days', 'Dexamethasone Ophthalmic Soln 0.1% 4 DROP LEFT EAR BID Duration: 10 Days']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 35, 'gender': 'M', 'symptoms': 'abdominal pain\nrecurrent pelvic abscesses', 'medical_history': [], 'family_history': None, 'present_illness': None, 'medications': [{'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', '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': '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 via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tuberculin Protein', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'ID', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, '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': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.7', 'valuenum': 48.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.3', 'valuenum': 43.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '264', 'valuenum': 264.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.34', 'valuenum': 5.34, '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': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '7.1', 'valuenum': 7.1, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 289.0, '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '9.7', 'valuenum': 9.7, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', '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': '49.3', 'valuenum': 49.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '317', 'valuenum': 317.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.42', 'valuenum': 5.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '___', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'STAT', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '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': 'TR', 'valuenum': None, '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': '1.026', 'valuenum': 1.026, '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': '47.8', 'valuenum': 47.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '268', 'valuenum': 268.0, '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': '5.18', 'valuenum': 5.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '4.1', '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': '138', 'valuenum': 138.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'EXAM ON DISCHARGE\n\nVitals: VS reviewed and normal, AF\nGen: NAD, A&O x 3\nCV: RRR\nResp: no acute respiratory distress, coarse breath sounds b/l\nAbd: soft, appropriately tender, no rebound/guarding, incision \nc/d/i\nExt: no TTP', 'diagnoses': [{'icd_code': '2250', 'desc': 'Benign neoplasm of brain'}], 'summary': "=====================================\nLabs\n=====================================\n___ 05:30AM BLOOD WBC-4.9 RBC-4.12 Hgb-13.2 Hct-39.4 MCV-96 \nMCH-32.0 MCHC-33.5 RDW-13.7 RDWSD-49.1* Plt ___\n___ 08:10AM BLOOD WBC-4.7 RBC-3.98 Hgb-12.6 Hct-37.8 MCV-95 \nMCH-31.7 MCHC-33.3 RDW-13.9 RDWSD-49.0* Plt ___\n___ 09:20AM BLOOD WBC-7.0 RBC-4.29 Hgb-13.8 Hct-42.4 \nMCV-99* MCH-32.2* MCHC-32.5 RDW-14.4 RDWSD-52.3* Plt ___\n___ 08:10AM BLOOD Neuts-49.4 ___ Monos-16.8* \nEos-2.6 Baso-0.9 Im ___ AbsNeut-2.32 AbsLymp-1.41 \nAbsMono-0.79 AbsEos-0.12 AbsBaso-0.04\n___ 09:20AM BLOOD Neuts-61.6 ___ Monos-13.3* \nEos-0.4* Baso-0.4 Im ___ AbsNeut-4.31# AbsLymp-1.67 \nAbsMono-0.93* AbsEos-0.03* AbsBaso-0.03\n___ 05:30AM BLOOD Glucose-89 UreaN-8 Creat-0.6 Na-138 K-4.7 \nCl-104 HCO3-25 AnGap-14\n___ 09:20AM BLOOD Glucose-93 UreaN-6 Creat-0.7 Na-136 K-4.4 \nCl-96 HCO3-29 AnGap-15\n___ 05:30AM BLOOD ALT-17 AST-18 AlkPhos-47 TotBili-0.4 \nDirBili-<0.2 IndBili-0.4\n___ 05:30AM BLOOD Albumin-3.5 Calcium-8.7 Phos-3.4 Mg-1.9\n___ 01:00PM BLOOD HBsAg-Negative\n___ 05:30AM BLOOD CRP-10.1*\n___ 01:00PM BLOOD HIV Ab-Negative\n\n=====================================\nImaging\n=====================================\nCT Abdomen/Pelvis ___\nIMPRESSION:\n1. Small fluid collection in the mid pelvis at the site of prior \nabscess. \nCollection measures 1.8 x 1.1 x 2.3 cm and given contained gas \nmay communicate\nthrough a tiny fistula with the adjacent sigmoid colon.\n2. Small amount of intermediate density free fluid in the \npelvis.\nOn ___, Ms. ___ was admitted to the gynecology service \nfor management of her a suspected recurrent pelvic abscess. \n\nUpon admission, she was noted to be hemodynamically stable and \nafebrile. CT scan showed small fluid collection that may \ncommunicate through a tiny fistula with the adjacent sigmoid \ncolon. Her pain was controlled with ibuprofen and tylenol as \nneeded. Antibiotics were held given that she was afebrile and \nher white count was 7.0. \n\nOn hospital day #1, Interventional Radiology was consulted for \npossible ___ guided drainage of her pelvic collection. Per ___, \nthe collection was too small with too close a proximity to \nsurrounding bowel for safe drainage. Infectious disease was also \nconsulted for proposed antibiotics regimen given the patient's \nhistory of polymicrobial abscesses. They recommended obtaining \nblood cultures, STI triple screen (vaginal swab, urine, throat) \nalong with Hepatitis B and C and HIV. At time of discharge, \nthese tests were negative. Once these were drawn, she was \nstarted on PO augmentin for a likely 14 day course. \n\nGiven the CT findings, ID recommended consulting GI due to \nconcern for Crohn's disease. She was kept NPO overnight on HD#1 \nfor possible imaging and diagnostic evaluation. However, given \nher lack of a history with classic signs and symptoms of \nCrohn's, this was felt to be less likely by GI however they \nconcurred with the antibiotic regimen. It was suggested she be \nseen as outpatient with GI. \n\nBy hospital day 2, she was tolerating a regular diet, ambulating \nindependently, and pain was controlled with oral medications. \nShe was then discharged home in stable condition with outpatient \nfollow-up scheduled."}}
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{'final_diagnoses': ["Suspected Recurrent pelvic abscess but can't rule out GI source"], 'procedures': ['none'], 'visit_summary': "On ___, Ms. ___ was admitted to the gynecology service \nfor management of her a suspected recurrent pelvic abscess. \n\nUpon admission, she was noted to be hemodynamically stable and \nafebrile. CT scan showed small fluid collection that may \ncommunicate through a tiny fistula with the adjacent sigmoid \ncolon. Her pain was controlled with ibuprofen and tylenol as \nneeded. Antibiotics were held given that she was afebrile and \nher white count was 7.0. \n\nOn hospital day #1, Interventional Radiology was consulted for \npossible ___ guided drainage of her pelvic collection. Per ___, \nthe collection was too small with too close a proximity to \nsurrounding bowel for safe drainage. Infectious disease was also \nconsulted for proposed antibiotics regimen given the patient's \nhistory of polymicrobial abscesses. They recommended obtaining \nblood cultures, STI triple screen (vaginal swab, urine, throat) \nalong with Hepatitis B and C and HIV. At time of discharge, \nthese tests were negative. Once these were drawn, she was \nstarted on PO augmentin for a likely 14 day course. \n\nGiven the CT findings, ID recommended consulting GI due to \nconcern for Crohn's disease. She was kept NPO overnight on HD#1 \nfor possible imaging and diagnostic evaluation. However, given \nher lack of a history with classic signs and symptoms of \nCrohn's, this was felt to be less likely by GI however they \nconcurred with the antibiotic regimen. It was suggested she be \nseen as outpatient with GI. \n\nBy hospital day 2, she was tolerating a regular diet, ambulating \nindependently, and pain was controlled with oral medications. \nShe was then discharged home in stable condition with outpatient \nfollow-up scheduled.", 'medications_prescribed': ['Amoxicillin-Clavulanic Acid ___ mg PO Q12H \nPlease continue taking until your follow up appointment with \nInfectious Disease ___ \nRX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by \nmouth twice a day Disp #*30 Tablet Refills:*0 ', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheezing']}
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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': 'Lightheadedness', 'medical_history': ['Type 2 diabetes Mellitus', 'Hyperlipidemia', 'Hypertension', 'Nephrolithiasis', 'Gastritis', 'Diverticulosis', 'Colon adenomas', 'Coronary artery disease'], 'family_history': 'Premature coronary artery disease- Father died at the age of ___ \nof "blood clots", Mother with multiple MI\'s, CABG and died in \nher late ___, issues started at age ___', 'present_illness': 'Mr. ___ is a ___ year-old man with PMH significant for \nCAD s/p recent 4vCABG ___, HTN, HLD, and T2DM who presents \nwith presyncope.\nThe patient was recently admitted ___ for scheduled \nCABG. Per discharge summary, post-operative course was \nuncomplicated and he was discharged on to ___ on POD 6. \nOf note, patient was started on the following new medications: \naspirin 81mg, metoprolol 50mg TID, PO amiodarone load, \nfurosemide 20mg daily, and bowel regimen.\n\nThe patient now represents with episodes of presyncope that \nstart with a hot/flushing sensation that progress to feeling \nlightheaded and are associated with palpitations. He notes that \nthe majority of these episodes occur in the morning after he \nwakes up, and multiple times occur after he urinates (but now \nwith bowel movements). He does not think they are related to \nexertion or to medication administration. Of note, he has no had \nactual loss of consciousness.\n\nIn ___ ED:\n- Initial VS 98 78 127/58 16 99% RA\n- Labs with Chem-10 wnl (Cr 1.0 from 0.8 on discharge), CBC with \nH/H ___ otherwise wnl, D-dimer 3313, UA neg\n- EKG with NSR@75, NANI, incomplete RBBB, Q-waves in III and \naVF, decreased voltage compared to prior\n- CXR with trace left pleural effusion improved from prior. CTA \nChest without PE with expected post-op changes.\n- Per report, bedside ultrasound with "Trace pericardial \neffusion, no tamponade physiology"\n- C-surg evaluated the patient in ED and noted that the patient \nhad an episode \n\nIn the ED while monitored on telemetry without changes. As such, \nthey recommended that the patient "return to rehab to continue \nPhysical Therapy to build endurance with the goal of\nprogressing to discharge home"\n- Patient was administered\n___ 13:42 PO/NG OxyCODONE (Immediate Release) 10 mg\n___ 14:03 PO/NG Metoprolol Tartrate 50 mg ___\n___ 16:45 PO/NG OxyCODONE (Immediate Release) 10 mg\n___ 19:26 PO OxycoDONE (Immediate Release) 10 mg\n___ 22:25 PO/NG Metoprolol Tartrate 50 mg ___\n___ 22:25 PO OxycoDONE (Immediate Release) 10 mg\n- VS at the time of transfer 98.6 81 139/98 16 98% RA\n\nUpon arrival to the floor, VS 98.8 142/91 80 18 100%RA. The \npatient reports \npain over surgical incision site as well as chronic cervicalgia \npain.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'DiCYCLOmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', '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': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Gabapentin', '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': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.56', 'valuenum': 2.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '100', 'valuenum': 100.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '58', 'valuenum': 58.0, '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': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '310', 'valuenum': 310.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVital Signs: 98.8 142/91 80 18 100%RA\nOrthostatics: sitting BP 120/72 HR 63 -> standing BP 108/63 HR \n67\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, \nneck supple, JVP not elevated, no LAD\nCV: Sternotomy scar healing well without surrounding erythema or \ndrainage. Regular rate and rhythm, normal S1 + S2, no murmurs, \nrubs, gallops\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi\nAbdomen: Distended but soft, non0tender, bowel sounds present, \nno rebound or guarding\nGU: No foley\nExt: Trace edema bilaterally. Otherwise, warm, well perfused, 2+ \npulses, no clubbing, or cyanosis\nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred.\n\nDISCHARGE PHYSICAL EXAM:\nVital Signs: 98.3, 105/62-120/64, 63-75, 18, 100%RA\nOrthostatics: negative\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, \nneck supple, JVP not elevated, no LAD\nCV: Sternotomy scar healing well without surrounding erythema or \ndrainage. Regular rate and rhythm, normal S1 + S2, no murmurs, \nrubs, gallops\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi\nAbdomen: Distended but soft, nontender, bowel sounds present, no \nrebound or guarding\nGU: No foley\nExt: Otherwise, warm, well perfused, 2+ pulses, no edema\nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, normal gait.', 'diagnoses': [{'icd_code': '78959', 'desc': 'Other ascites'}, {'icd_code': '07071', 'desc': 'Unspecified viral hepatitis C with hepatic coma'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '5723', 'desc': 'Portal hypertension'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': '55090', 'desc': 'Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}, {'icd_code': '72981', 'desc': 'Swelling of limb'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '2689', 'desc': 'Unspecified vitamin D deficiency'}, {'icd_code': '17361', 'desc': 'Basal cell carcinoma of skin of upper limb, including shoulder'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': '4401', 'desc': 'Atherosclerosis of renal artery'}, {'icd_code': '5571', 'desc': 'Chronic vascular insufficiency of intestine'}, {'icd_code': '7852', 'desc': 'Undiagnosed cardiac murmurs'}, {'icd_code': '7231', 'desc': 'Cervicalgia'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '53011', 'desc': 'Reflux esophagitis'}, {'icd_code': '2662', 'desc': 'Other B-complex deficiencies'}, {'icd_code': '2113', 'desc': 'Benign neoplasm of colon'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V5869', 'desc': 'Long-term (current) use of other medications'}], 'summary': "ADMISSION LABS:\n___ 11:28AM BLOOD WBC-9.4 RBC-3.62* Hgb-11.7* Hct-34.3* \nMCV-95 MCH-32.3* MCHC-34.1 RDW-11.7 RDWSD-40.3 Plt ___\n___ 11:28AM BLOOD Neuts-75.2* Lymphs-16.5* Monos-5.4 \nEos-1.2 Baso-0.6 Im ___ AbsNeut-7.09* AbsLymp-1.55 \nAbsMono-0.51 AbsEos-0.11 AbsBaso-0.06\n___ 11:28AM BLOOD Glucose-218* UreaN-19 Creat-1.0 Na-136 \nK-4.4 Cl-96 HCO3-31 AnGap-13\n___ 11:28AM BLOOD Calcium-10.0 Phos-3.0 Mg-2.0\n___ 11:28AM BLOOD D-Dimer-3313*\n\nIMAGING / STUDIES:\n- ___ RLE Ultrasound: No evidence of deep venous thrombosis \nin the right lower extremity veins. \n\n- ___ CTA Chest: 1. No evidence of pulmonary embolism or \naortic abnormality. 2. Trace left pleural effusion with mild \nleft lower lobe atelectasis. 3. Status-post recent median \nsternotomy with small amount of soft tissue stranding and fluid \nbehind the sternum which could be within normal limits \nimmediately postoperatively.\n\n- ___ CXR: Trace left pleural effusion, decreased compared \nto the prior study, with overlying atelectasis. No overt \npulmonary edema.\n\n- ___ ECG: NSR@75, NANI, incomplete RBBB, Q-waves in III and \naVF, decreased voltage compared to prior\n\nDISCHARGE LABS:\n___ 06:38AM BLOOD WBC-7.7 RBC-3.28* Hgb-10.3* Hct-31.3* \nMCV-95 MCH-31.4 MCHC-32.9 RDW-12.1 RDWSD-42.1 Plt ___\n___ 06:38AM BLOOD Glucose-189* UreaN-16 Creat-1.0 Na-137 \nK-4.2 Cl-98 HCO3-31 AnGap-12\n___ 06:38AM BLOOD Calcium-9.7 Phos-4.1 Mg-1.___\nwith CAD s/p recent 4vCABG ___, HTN, HLD, and T2DM who \npresents with presyncope.\n\n# Presyncope: Patient with several days of presyncopal episodes \noccurring ~2x/day, consistent with of fleeing flushed and \nlightheaded after sitting in up in AM or after urinating. Likely \nmultifactorial with components of orthostasis (orthostatics \npositive with 20mmHg BP drop) as well as vasovagal. Given recent \ncardiac surgery and symptoms of palpitations (though after \nepisode rather than preceding), we considered arrhythmia but his \ntelemetry monitoring was without event and EKG was at baseline. \nHis D-dimer on admission was elevated >3000 but CTA and RLE \nultrasound were negative for clot. He had positive orthostatics \non admission and his furosemide was stopped (EF >55% on recent \nECHO), his amiodarone was reduced to 200 daily, and his \nmetoprolol was reduced to 100mg daily and changed to succinate. \nHis Oxycodone 15mg was also extended from Q3H to Q4H:PRN. His \ndizziness and lightheadedness resolved in the setting of his \nmedication changes and he was discharged home after working with \nphysical therapy. \n\n# CAD: s/p recent 4v CABG ___. Evaluated by C-surg and noted \nsurgical site to be well-appearing. Patient without chest pain \nor SOB to suggest ischemia, EKG without ischemic changes. His \naspirin 81, tylenol, oxycodone, and atorvastatin were continued.\n\n# AFib: Patient placed on PO amiodarone load without clear \ndocumentation of etiology in discharge summary. Patient mentions \nthat he had a-fib after his CABG. His dose was reduced to 200mg \ndaily after reviewing discharge notes and planned taper course. \n\n# Constipation: Patient with significant opioid induced \nconstipation. He was treated and discharged with an aggressive \nbowel regimen for constipation. This included standing senna, \ncolace, and bisacodyl with lactulose, miralax PRN. He required \none dose of magnesium citrate while inpatient which relieved his \nconstipation, but caused some abdominal cramping.\n\n# HLD: Continued atorvastatin 40mg daily\n\n# T2DM: Initially on insulin sliding scale then resumed \nmetformin 1000 BID.\n\n# GERD: Continued Nexium 40mg BID\n\nTRANSITIONAL ISSUES:\n- Patient discharge off furosemide and potassium supplemetation. \nECHO showed normal systolic function (LVEF >55%) and no clinical \nsigns of heart failure. He was instructed to weight himself \ndaily and call MD if weight is >3lbs 2 days in a row. Consider \nre-starting furosemide at a lower dose (10mg daily) if needed. \n- Patient's amiodarone was reduced to 200mg daily after 2 weeks \nof loading dose. Records do not outline circumstances under \nwhich amiodarone was started but they do mention atrial \nfibrillation. Consider stopping amiodarone if paroxysmal A-fib \nwas only in the setting of recent cardiac surgery.\n- Patient discharged on Tylenol ___ Q8H and oxycodone 15 mg \nQ4-6H:PRN for pain control. Please wean as tolerated.\n- Patient discharged with #13 tablets Oxycodone 15mg in hand. \nNext PCP appointment on ___. He was counseled on the \nrisks of opioid pain medications\n- Patient discharged on aggressive bowel regimen for opioid \ninduced constipation. Bowel regimen includes: senna 8.6 BID, \nColace 100 BID, miralax 17g daily:PRN, bisacodyl 10 daily:PRN, \nand lactulose 60mL daily. Please continue to monitor for \nconstipation.\n- Patient was re-started on metformin 1000 BID for T2DM, he has \nlost weight recently secondary to surgery and hospital stay. \nPlease continue to monitor blood glucose and adjust regimen as \nneeded. Recommend repeat HgbA1c at next PCP follow up \nappointment. \n- Patient discharged on amiodarone, recommend routine monitoring \nof LFTs.\n- Patient discharged with script for outpatient physical therapy \nfor continued ___ rehabilitation and home visiting \nnurse.\n# CODE: Full (confirmed)\n# CONTACT: ___ (___)"}}
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{'final_diagnoses': ['Orthostatic hypotension', 'Coronary artery disease s/p CABG', 'Paroxysmal atrial fibrillation', 'Chronic pain', 'Opioid induced constipation', 'Hyperlipidemia', 'Hypertension', 'Type 2 diabetes'], 'procedures': ['None'], 'visit_summary': "with CAD s/p recent 4vCABG ___, HTN, HLD, and T2DM who \npresents with presyncope.\n\n# Presyncope: Patient with several days of presyncopal episodes \noccurring ~2x/day, consistent with of fleeing flushed and \nlightheaded after sitting in up in AM or after urinating. Likely \nmultifactorial with components of orthostasis (orthostatics \npositive with 20mmHg BP drop) as well as vasovagal. Given recent \ncardiac surgery and symptoms of palpitations (though after \nepisode rather than preceding), we considered arrhythmia but his \ntelemetry monitoring was without event and EKG was at baseline. \nHis D-dimer on admission was elevated >3000 but CTA and RLE \nultrasound were negative for clot. He had positive orthostatics \non admission and his furosemide was stopped (EF >55% on recent \nECHO), his amiodarone was reduced to 200 daily, and his \nmetoprolol was reduced to 100mg daily and changed to succinate. \nHis Oxycodone 15mg was also extended from Q3H to Q4H:PRN. His \ndizziness and lightheadedness resolved in the setting of his \nmedication changes and he was discharged home after working with \nphysical therapy. \n\n# CAD: s/p recent 4v CABG ___. Evaluated by C-surg and noted \nsurgical site to be well-appearing. Patient without chest pain \nor SOB to suggest ischemia, EKG without ischemic changes. His \naspirin 81, tylenol, oxycodone, and atorvastatin were continued.\n\n# AFib: Patient placed on PO amiodarone load without clear \ndocumentation of etiology in discharge summary. Patient mentions \nthat he had a-fib after his CABG. His dose was reduced to 200mg \ndaily after reviewing discharge notes and planned taper course. \n\n# Constipation: Patient with significant opioid induced \nconstipation. He was treated and discharged with an aggressive \nbowel regimen for constipation. This included standing senna, \ncolace, and bisacodyl with lactulose, miralax PRN. He required \none dose of magnesium citrate while inpatient which relieved his \nconstipation, but caused some abdominal cramping.\n\n# HLD: Continued atorvastatin 40mg daily\n\n# T2DM: Initially on insulin sliding scale then resumed \nmetformin 1000 BID.\n\n# GERD: Continued Nexium 40mg BID\n\nTRANSITIONAL ISSUES:\n- Patient discharge off furosemide and potassium supplemetation. \nECHO showed normal systolic function (LVEF >55%) and no clinical \nsigns of heart failure. He was instructed to weight himself \ndaily and call MD if weight is >3lbs 2 days in a row. Consider \nre-starting furosemide at a lower dose (10mg daily) if needed. \n- Patient's amiodarone was reduced to 200mg daily after 2 weeks \nof loading dose. Records do not outline circumstances under \nwhich amiodarone was started but they do mention atrial \nfibrillation. Consider stopping amiodarone if paroxysmal A-fib \nwas only in the setting of recent cardiac surgery.\n- Patient discharged on Tylenol ___ Q8H and oxycodone 15 mg \nQ4-6H:PRN for pain control. Please wean as tolerated.\n- Patient discharged with #13 tablets Oxycodone 15mg in hand. \nNext PCP appointment on ___. He was counseled on the \nrisks of opioid pain medications\n- Patient discharged on aggressive bowel regimen for opioid \ninduced constipation. Bowel regimen includes: senna 8.6 BID, \nColace 100 BID, miralax 17g daily:PRN, bisacodyl 10 daily:PRN, \nand lactulose 60mL daily. Please continue to monitor for \nconstipation.\n- Patient was re-started on metformin 1000 BID for T2DM, he has \nlost weight recently secondary to surgery and hospital stay. \nPlease continue to monitor blood glucose and adjust regimen as \nneeded. Recommend repeat HgbA1c at next PCP follow up \nappointment. \n- Patient discharged on amiodarone, recommend routine monitoring \nof LFTs.\n- Patient discharged with script for outpatient physical therapy \nfor continued ___ rehabilitation and home visiting \nnurse.\n# CODE: Full (confirmed)\n# CONTACT: ___ (___)", 'medications_prescribed': ['Acetaminophen 975 mg PO TID', 'Amiodarone 200 mg PO DAILY', 'Aspirin EC 81 mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Bisacodyl ___AILY:PRN constipation', 'Docusate Sodium 100 mg PO BID', 'Lactulose 60 mL PO DAILY', 'MetFORMIN (Glucophage) 1000 mg PO BID', 'NexIUM (esomeprazole magnesium) 40 mg oral BID', 'OxyCODONE (Immediate Release) 15 mg PO Q3H:PRN pain', 'Senna 8.6 mg PO BID', 'Metoprolol Succinate XL 100 mg PO DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation']}
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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': 'leukocytosis, hyponatremia', 'medical_history': ['1. Hepatitis C cirrhosis w/ portal hypertension, esophageal \nvarices (grade 2 ___, and thrombocytopenia. Non responder \nto interferon monotherapy and to interferon with ribavirin.', '2. Hypertension', '3. Upper GI bleed due to gastritis.', '4. Healed antral ulcer on EGD ___', '5. Chronic epistaxis'], 'family_history': 'Brother with ___ C cirrhosis s/p liver transplant', 'present_illness': '___ HCV nonresponder with cirrhosis c/b portal hypertension, \nesophageal varices and thrombocytopenia presents after stopping \nhis medications 1 weeks ago and then presetning to liver clinic \nwith leukocytosis and hypervolemic hyponatremia.\n.\nThe patient states that he feels as though there is something \nelse going on besides his liver disease. He also felt dizzy and \nhad low blood pressure while on the medications. He states that \nbecause of this he stopped his medications including lasix, \nspironolactone, nadolol, lactulose and rifaximin. He states that \neverything thing was going well and he felt great while he was \noff his meds. Then he talked to ___ RN on ___ who \nconvinced him to ___ hs lasix, aldactone and nadolol. Since he \nrestarted these meds he has noticed increased lower extremity \nedema, fatigue, lightheadedness and shortness of breath. He \npresented to liver clinic where he was found to have \nhypervolemic hyponatremia and leukocytosis and was admitted to \nthe hospital.\n.\nOf note the patient has had epistaxis, odynophagia and tongue \nulcers for "multiple months". The patient denies fevers, chills, \nnight sweats, weight loss, N/V, confusion, falls/trauma, CP, \ncough, dysuria, abdominal pain, diarrhea, constipations, \nmyalgias or arthralgias.', 'medications': [{'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Citalopram', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': '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': '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': '38.7', 'valuenum': 38.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '210', 'valuenum': 210.0, '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': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '46.4', 'valuenum': 46.4, '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': '9.2', 'valuenum': 9.2, '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': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2, . estimated GFR (eGFR) is likely between 44 and 53 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': 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': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T: 97.4 BP: 106/55 P: 88 R: 20 O2: 97% RA\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera slightly icteric, mucous membranes moist, no \nmucosal plaques, moderate size ulceration on left side of \ntongue, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: left basilar crackles, otherwise CTA\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops\nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding\nExt: Warm, well perfused, 2+ pulses, 2+ pitting edema to the \nknees bilaterally, right thigh with a firm, warm, erythematous, \npainful area spanning from above the knee approx 5-6 cm up the \nthigh, no crepitus', 'diagnoses': [{'icd_code': 'G912', 'desc': '(Idiopathic) normal pressure hydrocephalus'}, {'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6832', 'desc': 'Body mass index [BMI] 32.0-32.9, adult'}], 'summary': '___ 12:35PM WBC-15.4*# RBC-2.50* HGB-8.3* HCT-24.7*\nMCV-99* MCH-33.2* MCHC-33.6 RDW-18.5*\n___ 12:35PM UREA N-31* CREAT-1.2 SODIUM-122* \nPOTASSIUM-4.6 CHLORIDE-96 TOTAL CO2-21* ANION GAP-10\n___ 09:10PM ___ PTT-40.9* ___\n___ 09:10PM ALBUMIN-2.2* CALCIUM-8.1* PHOSPHATE-2.6* \nMAGNESIUM-2.4\n___ 09:10PM ALT(SGPT)-88* AST(SGOT)-195* LD(LDH)-532* ALK \nPHOS-264* TOT BILI-9.9*\n.\n___ CXR: PA AND LATERAL CHEST RADIOGRAPHS: The \ncardiomediastinal and hilar contours are normal. The lungs are \nwell expanded. The increased lucency of the upper lung zones, \nsuggests underlying emphysematous changes. The lungs are clear \nwithout evidence of focal consolidations. The pulmonary \nvasculature is not engorged. The pleural surfaces are smooth \nwithout evidence of pleural effusion. There is a new anterior \nwedge compression fracture involving a mid thoracic vertebra, \nwhich is new since the CT done on ___. \nIMPRESSION: 1. No evidence of pneumonia. 2. Anterior wedge \ncompression of the thoracic vertebra, new since ___. \n.\n___ Abdomen U/S with doppler: FINDINGS: There is a \npersistently coarsened echotexture and nodular surface \nconsistent with known history of cirrhosis. There is sludge \nwithin the gallbladder. There is gallbladder wall thickening, \ncould be due to underlying ascites, or underlying liver disease. \nThere is small amount of fluid at the gallbladder, and around \nthe spleen. No free fluid is seen in the right or left lower \nabdominal quadrant.\nThere is no intra- or extra-hepatic biliary duct dilatation. \nLimited \nevaluation of pancreas due to overlapping bowel gas. The spleen \nmeasures 10.4 cm on the current study. The main portal vein is \npatent with normal flow. \nIMPRESSION: 1. No sonographic evidence of portal venous \nthrombosis. Portal vein flow is hepatopetal and wall-to-wall. 2. \nMinimal amount of ascites. \n3. Persistent coarsened echotexture of the liver consistent with \nknown \nhistory of cirrhosis. 4. Sludge in the gallbladder with \ngallbladder wall thickening, could be due to underlying disease, \nor ascites.\n.\n___ HCV nonresponder with cirrhosis c/b hypervolemic \nhyponatremia, grade 2 varices, encephalopathy who stopped meds 1 \nweek prior now p/w leukocytosis and hypervolemic hyponatremia.\n.\n#. Hyponatremia: The patient appears to have chronic \nhyponatremia, which has been documented on previous admissions. \nHis admission sodium was 122. He had not been taking his \nmedications of spironolactone and furosemide at home for the \nprior week. He was restarted on his diuretics and his fluid \nintake was decreased to 1200ccs per day. He was started on \ntolvaptan 15mg PO daily. His sodium increased to 132. The \npatient felt much better. He was discharged with with tolvaptan \nand will have close follow up with Dr. ___. \n.\n#. Leukocytosis: The patient presented with an elevated white \ncount without fevers or localizing symptoms. The patient had no \nabdominal pain and trace ascites behind his spleen. CXR was \nclear and UA negative for infection. Blood show no growth to \ndate and urine cultures were negative. He had a small area on \nhis right thigh with mild tenderness and mild erythema without \nwarmth or discharge. He did note some oral ulcers which were \nmost likely apthous and unlikely to cause leukocytosis. His WBC \ntrended down 9 on the day of discharge and he remained afebrile \nwithout localizing symptoms.\n.\n#. Lower extremity edema: This is most likely secondary to \nstopping medciations and low albumin. The patient was restarted \non his diuretics of furosemide and spironolactone. He responded \nwell with good urine output and weight loss with stable \ncreatinine.\n.\n#. Anemia: The patient has a baseline hct of ___. He was \nadmitted with a hct of 24.7. He had some evidence of bleeding in \nhis R nare and some blood in his posterior oropharynx. His hct \ntrended down to 21 without any signs of bleeding and being \nguiaic negative. His hct was 23.3 on discharge.\n.\n#. HCV Cirrhosis: The patient was restarted on his home doses of \nlactulose, rifaximin, nadolol, spironolactone and furosemide. He \nhad no evidence of encephalopathy and his MELD labs were stable.\n.\n#. Vertebral fracture: The patient has a vertebral fracture \nwhich was incidentially picked up on a chest x-ray. It was \nrecommended that the patient get a dexa-scan as an outpatient. \nHe was also started on calcium and vitamin-D supplements.'}}
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{'final_diagnoses': ['Hyponatremia', 'Lower extremity swelling', 'Cirrhosis'], 'procedures': ['None'], 'visit_summary': '___ HCV nonresponder with cirrhosis c/b hypervolemic \nhyponatremia, grade 2 varices, encephalopathy who stopped meds 1 \nweek prior now p/w leukocytosis and hypervolemic hyponatremia.\n.\n#. Hyponatremia: The patient appears to have chronic \nhyponatremia, which has been documented on previous admissions. \nHis admission sodium was 122. He had not been taking his \nmedications of spironolactone and furosemide at home for the \nprior week. He was restarted on his diuretics and his fluid \nintake was decreased to 1200ccs per day. He was started on \ntolvaptan 15mg PO daily. His sodium increased to 132. The \npatient felt much better. He was discharged with with tolvaptan \nand will have close follow up with Dr. ___. \n.\n#. Leukocytosis: The patient presented with an elevated white \ncount without fevers or localizing symptoms. The patient had no \nabdominal pain and trace ascites behind his spleen. CXR was \nclear and UA negative for infection. Blood show no growth to \ndate and urine cultures were negative. He had a small area on \nhis right thigh with mild tenderness and mild erythema without \nwarmth or discharge. He did note some oral ulcers which were \nmost likely apthous and unlikely to cause leukocytosis. His WBC \ntrended down 9 on the day of discharge and he remained afebrile \nwithout localizing symptoms.\n.\n#. Lower extremity edema: This is most likely secondary to \nstopping medciations and low albumin. The patient was restarted \non his diuretics of furosemide and spironolactone. He responded \nwell with good urine output and weight loss with stable \ncreatinine.\n.\n#. Anemia: The patient has a baseline hct of ___. He was \nadmitted with a hct of 24.7. He had some evidence of bleeding in \nhis R nare and some blood in his posterior oropharynx. His hct \ntrended down to 21 without any signs of bleeding and being \nguiaic negative. His hct was 23.3 on discharge.\n.\n#. HCV Cirrhosis: The patient was restarted on his home doses of \nlactulose, rifaximin, nadolol, spironolactone and furosemide. He \nhad no evidence of encephalopathy and his MELD labs were stable.\n.\n#. Vertebral fracture: The patient has a vertebral fracture \nwhich was incidentially picked up on a chest x-ray. It was \nrecommended that the patient get a dexa-scan as an outpatient. \nHe was also started on calcium and vitamin-D supplements.', 'medications_prescribed': ['Lactulose 10 gram Packet Sig: Three (3) PO once a day.\nDisp:*90 packets* Refills:*2*', 'Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a \nday).', 'Tolvaptan 15 mg Tablet Sig: One (1) Tablet PO daily ().\nDisp:*30 Tablet(s)* Refills:*2*', 'Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day).\nDisp:*90 Tablet, Chewable(s)* Refills:*2*', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 64, 'gender': 'M', 'symptoms': 'Right knee pain', 'medical_history': ['- Hypertension', '- Hyperlipidemia', '- h/o MVA ___, with severe trauma to leg and abdomen, requiring\ncolostomy', '- h/o provoked DVT following prolonged immobilization after MVA\nin ___, completed 3 months of full AC', '- Rosacea', '- Urinary retention', '- s/p L hip replacement ___', '- Multiple basal cell carcinoma, most recent MOHS ___', '- s/p L knee replacement ___'], 'family_history': 'Non-contributory', 'present_illness': '___ year old male with right knee arthritis status post right \ntotal knee arthroplasty ___ ___.', 'medications': [{'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Entecavir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diphenoxylate-Atropine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Cream 2.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diphenoxylate-Atropine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Opium Tincture', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', '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}]}, 'clinical_findings': {'labs': [{'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': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, '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': '0.5', '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.66', 'valuenum': 0.66, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '345', 'valuenum': 345.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '9', 'valuenum': 9.0, '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, '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': '26.9', 'valuenum': 26.9, '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': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, '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}], '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': '72887', 'desc': 'Muscle weakness (generalized)'}, {'icd_code': '7837', 'desc': 'Adult failure to thrive'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '78760', 'desc': 'Full incontinence of feces'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '1629', 'desc': 'Malignant neoplasm of bronchus and lung, unspecified'}, {'icd_code': '1983', 'desc': 'Secondary malignant neoplasm of brain and spinal cord'}, {'icd_code': '1975', 'desc': 'Secondary malignant neoplasm of large intestine and rectum'}, {'icd_code': '1969', 'desc': 'Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified'}, {'icd_code': '28522', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': '7821', 'desc': 'Rash and other nonspecific skin eruption'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '07032', 'desc': 'Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta'}, {'icd_code': 'V850'}, {'icd_code': 'V5864', 'desc': 'Long-term (current) use of non-steroidal anti-inflammatories (NSAID)'}, {'icd_code': 'V1588', 'desc': 'History of fall'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "___ 07:00AM BLOOD Hgb-9.6* Hct-29.3*\n___ 06:10AM BLOOD Hgb-9.4* Hct-29.7*\n___ 06:40AM BLOOD Hgb-10.0* Hct-30.8*\n___ 07:20AM BLOOD Hgb-9.8* Hct-30.1*\n___ 07:10AM BLOOD Hgb-10.8* Hct-34.3*\n___ 07:00AM BLOOD Glucose-103* UreaN-14 Creat-0.7 Na-137 \nK-4.8 Cl-100 HCO3-26 AnGap-11\n___ 02:40PM BLOOD Glucose-97 UreaN-17 Creat-0.6 Na-135 \nK-4.2 Cl-97 HCO3-25 AnGap-13\n___ 06:10AM BLOOD Glucose-100 UreaN-17 Creat-0.7 Na-136 \nK-3.7 Cl-96 HCO3-26 AnGap-14\n___ 01:10PM BLOOD Glucose-134* UreaN-13 Creat-0.7 Na-136 \nK-4.1 Cl-97 HCO3-28 AnGap-11\n___ 06:40AM BLOOD Glucose-112* UreaN-13 Creat-0.7 Na-137 \nK-4.6 Cl-98 HCO3-26 AnGap-13\n___ 09:40PM BLOOD Glucose-137* UreaN-12 Creat-0.7 Na-136 \nK-3.7 Cl-99 HCO3-27 AnGap-10\n___ 03:30PM BLOOD Na-132*\n___ 08:50AM BLOOD Glucose-101* UreaN-12 Creat-0.6 Na-130* \nK-4.1 Cl-95* HCO3-26 AnGap-9*\n___ 07:20AM BLOOD Creat-0.7\n___ 07:10AM BLOOD Creat-0.8\n___ 08:50AM BLOOD cTropnT-<0.01\n___ 07:00AM BLOOD Calcium-8.4 Phos-4.4 Mg-2.0\n___ 02:40PM BLOOD Calcium-8.2* Phos-4.0 Mg-1.8\n___ 06:10AM BLOOD Calcium-8.2* Phos-3.5 Mg-1.9\n___ 01:10PM BLOOD Calcium-8.5 Phos-2.6* Mg-1.8\n___ 06:40AM BLOOD Calcium-8.3* Phos-2.9 Mg-1.9\n___ 09:40PM BLOOD Calcium-7.9* Phos-2.8 Mg-1.8\n___ 08:50AM BLOOD Calcium-7.9* Phos-2.6* Mg-1.6\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\nPostoperative course was remarkable for the following:\nPOD #0, patient was given 500ml fluid bolus for low urine \noutput. Tramadol was switched to Dilaudid due to worsening pain.\nPOD #1, patient was noted to have oxygen desaturations with ___ \nto the ___ and recovered quickly to 95% on room air. This was \nmonitored. Patient was unable to void with low bladder scan. He \nwas given another 500ml fluid bolus and started on Flomax. \nPatient was voiding after. Overnight patient was tachycardic \nwith heart rate sustaining in the 180s. EKG was obtained which \nshowed sinus with premature ventricular beats. Patient was \nadministered IV metoprolol x1 with heart rate improved to the \n___. He remained asymptomatic.\nPOD #2, hematocrit was 30.1. Electrolytes were obtained which \nmagnesium of 1.6 and phosphorus 2.6 were both repleted. Sodium \nwas 130 and patient was placed on a 1200 mL fluid restriction. \nRepeat sodium in the afternoon was 136. Troponins were negative \nx1. Patient remains tachycardic with O2 requirement up to 4 L \nand a CTA of the chest was obtained. Results showed no \npulmonary embolus, bilateral pleural effusions, and small areas \nof consolidation in the left lower lobe. Cardiology was \nconsulted and recommended IV Lasix bolus for volume overload \nalong with daily weights and twice daily lab checks. He \ndiuresed overnight appropriately.\nPOD #3, the patient was still requiring up to 4 liters and his \nheart rate was up to 140s at times. Per Cardiology, they \nrecommended another bolus of IV Lasix and to start him on \nVerapramil every 8 hours for better control of his heart rate. \nHis sodium was 137, so he was taken off the fluid restriction. \nPhosphate 2.6 in the afternoon and was repleted orally.\n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Enoxaparin 30 mg twice \ndaily for DVT prophylaxis starting on the morning of POD#1, \ntransitioned to 40 mg daily at discharge. The surgical dressing \nwill remain on until POD#7 after surgery. The patient was seen \ndaily by physical therapy. Labs were checked throughout the \nhospital 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 dressing was intact.\n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with no range of motion \nrestrictions. Please use walker or 2 crutches, wean as able. \n\nMr. ___ is discharged to home with services in stable \ncondition."}}
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{'final_diagnoses': ['Right knee arthritis'], 'procedures': ['Right total knee 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\nPostoperative course was remarkable for the following:\nPOD #0, patient was given 500ml fluid bolus for low urine \noutput. Tramadol was switched to Dilaudid due to worsening pain.\nPOD #1, patient was noted to have oxygen desaturations with ___ \nto the ___ and recovered quickly to 95% on room air. This was \nmonitored. Patient was unable to void with low bladder scan. He \nwas given another 500ml fluid bolus and started on Flomax. \nPatient was voiding after. Overnight patient was tachycardic \nwith heart rate sustaining in the 180s. EKG was obtained which \nshowed sinus with premature ventricular beats. Patient was \nadministered IV metoprolol x1 with heart rate improved to the \n___. He remained asymptomatic.\nPOD #2, hematocrit was 30.1. Electrolytes were obtained which \nmagnesium of 1.6 and phosphorus 2.6 were both repleted. Sodium \nwas 130 and patient was placed on a 1200 mL fluid restriction. \nRepeat sodium in the afternoon was 136. Troponins were negative \nx1. Patient remains tachycardic with O2 requirement up to 4 L \nand a CTA of the chest was obtained. Results showed no \npulmonary embolus, bilateral pleural effusions, and small areas \nof consolidation in the left lower lobe. Cardiology was \nconsulted and recommended IV Lasix bolus for volume overload \nalong with daily weights and twice daily lab checks. He \ndiuresed overnight appropriately.\nPOD #3, the patient was still requiring up to 4 liters and his \nheart rate was up to 140s at times. Per Cardiology, they \nrecommended another bolus of IV Lasix and to start him on \nVerapramil every 8 hours for better control of his heart rate. \nHis sodium was 137, so he was taken off the fluid restriction. \nPhosphate 2.6 in the afternoon and was repleted orally.\n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Enoxaparin 30 mg twice \ndaily for DVT prophylaxis starting on the morning of POD#1, \ntransitioned to 40 mg daily at discharge. The surgical dressing \nwill remain on until POD#7 after surgery. The patient was seen \ndaily by physical therapy. Labs were checked throughout the \nhospital 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 dressing was intact.\n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with no range of motion \nrestrictions. Please use walker or 2 crutches, wean as able. \n\nMr. ___ is discharged to home with services in stable \ncondition.", 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H', '2. Docusate Sodium 100 mg PO BID', '3. Enoxaparin Sodium 30 mg SC BID', '4. Gabapentin 300 mg PO TID', '5. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Severe', '6. Senna 8.6 mg PO BID', '7. Tamsulosin 0.4 mg PO QHS', '8. Verapamil SR 120 mg PO Q24H', '9. Atorvastatin 40 mg PO QPM', '10. Cephalexin ___ mg PO DAILY:PRN dental procedures', '11. Lisinopril 10 mg PO DAILY', '12. MetronidAZOLE Topical 1 % Gel 1 Appl TP DAILY', '13. 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': 21, 'gender': 'M', 'symptoms': 'difficulty walking, abdominal fullness', 'medical_history': ['- Diabetes mellitus, type 2 - last A1c 7.7 in ___', '- Obesity', '- Hypertension', '- Hypercholesteremia', '- Colonic Adenoma and h/o colonic polyps', '- H/o elevated PSA'], 'family_history': 'No history of kidney disease \n- F: deceased \n- M: deceased \n- Several sisters/brother alive', 'present_illness': 'This is a ___ with history of DM, HTN, HLD, obesity who \npresents from urgent care clinic with grossly abnormal labs. \n. \nPatient was in USOH until beginning of ___ when he developed \nlower back pain. After seeing his PCP, he was started on \nTylenol#3 and flexeril. He then represented on ___ for severe \nconstipation x 3 days. He was started on MOM with good results. \nAt this appt, he also complained of dysuria for which urine \nculture was obtained and was negative. He represented again on \n___ for severe constipation. Plan was to try OTC drugs and \nfollow up on ___. Per office note, patient appeared weak and \nhad protuberant abdomen. KUB from office note showed evidence of \n"paralytic ileus." Labs drawn showed a leukocytosis to 19 and \npotassium reportedly of 8.9. Pt was asked then to come to ED for \nfurther evaluation. \n. \nPer wife, pt was doing well up until this AM when she noted that \nhe appeared weaker than normal and was unable to stand on his \nown. Prior to today however he was walking without difficulty \nalthough was unable to go to work because of feeling tired and \nweak. No fevers, chills, URI symptoms, nausea, vomiting, \ndysuria, SOB, CP ___ swelling. Per wife he was voiding without \ndifficulty. \n. \nIn ED, initial VS 98 93 143/56 15 100%. Initial Labs reveal \ngross metabolic abnormalities including Bicarb 6, K 8.9. CT \nabdomen/pelvis showed massively distended bladder and b/l \nhydronephrosis. EKG reported showed "peaked T waves." Received \nkayexalate, dextrose, insulin and calcium. Renal was consulted \nfor urgent dialysis. Foley was placed drained over 1L of bloody \nurine. Pt was admitted to ICU for emergent dialysis. Prior to \ntransfer, VS were 87 127/54 16 98%RA. \n. \nIn MICU, pt was resting without any complaints. Stated that \nabdominal distension was better after foley insertion.', 'medications': [{'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Terbinafine 1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Aspirin', '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': 'Discontinued', 'route': 'IV', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Zolpidem Tartrate', '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', 'route': 'IV', 'frequency': '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': 'Magnesium Sulfate', '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': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, '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': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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 20-29 is 116 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '25', 'valuenum': 25.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '341', 'valuenum': 341.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '15.6', 'valuenum': 15.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '11.7', 'valuenum': 11.7, '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': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, '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': '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': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'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': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, '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': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, '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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, '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': '175', 'valuenum': 175.0, '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': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, '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': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'PHYSICAL EXAM:\nVS - TMax: 100.1 T 99.7 BP 140/78 (124/74-170/84) P 85 (85-92) \nRR ___ ___ 183 (167-328) 100%RA\nGENERAL - well-appearing male, supine and laying on right side, \nappropriately interactive A&O x 3\nHEENT - Mucous membranes moist. PERRL, EOMI, sclera anicteric \nNECK - supple, no JVD\nLUNGS - CTAB with good air movement bilaterially \nHEART - RRR, no MRG, nl S1-S2\nABDOMEN - normal bowel sounds, soft, non-tender\nEXTREMITIES - warm, dry, 2+ peripheral pulses. capillary refill \n<2 seconds\nNEURO - CNs II-XII grossly intact, able to follow commands\n\nPhysical Exam on Discharge:\nNeuro: fully ambulates, no asterixis\nPsych: A+Ox3, appropriate affect', 'diagnoses': [{'icd_code': '9041', 'desc': 'Injury to superficial femoral artery'}, {'icd_code': '9042', 'desc': 'Injury to femoral veins'}, {'icd_code': 'E9220', 'desc': 'Accident caused by handgun'}], 'summary': 'Lab results from admission:\n\n___ 08:31PM GLUCOSE-395* UREA N-80* CREAT-4.8*# \nSODIUM-134 POTASSIUM-4.3 CHLORIDE-92* TOTAL CO2-29 ANION GAP-17\n___ 08:31PM CALCIUM-8.0* PHOSPHATE-3.6 MAGNESIUM-2.4\n___ 08:31PM ASA-NEG ACETMNPHN-NEG bnzodzpn-NEG \nbarbitrt-NEG tricyclic-NEG\n___ 02:41PM GLUCOSE-444* UREA N-105* CREAT-7.1*# \nSODIUM-137 POTASSIUM-4.4 CHLORIDE-89* TOTAL CO2-30 ANION GAP-22*\n___ 02:41PM CALCIUM-8.2* PHOSPHATE-4.1 MAGNESIUM-2.8*\n___ 10:46AM GLUCOSE-290* UREA N-120* CREAT-10.3*# \nSODIUM-129* POTASSIUM-5.5* CHLORIDE-88* TOTAL CO2-21* ANION \nGAP-26*\n___ 10:46AM CK(CPK)-739*\n___ 10:46AM TOT PROT-6.5 CALCIUM-8.6 PHOSPHATE-4.6* \nMAGNESIUM-3.1*\n___ 10:46AM PSA-8.4*\n___ 10:46AM PEP-NO SPECIFI IgG-1263 IgA-238 IgM-49 IFE-NO \nMONOCLO\n___ 05:46AM GLUCOSE-238* UREA N-120* CREAT-11.9*# \nSODIUM-132* POTASSIUM-5.0 CHLORIDE-83* TOTAL CO2-19* ANION \nGAP-35*\n___ 05:46AM ALT(SGPT)-24 AST(SGOT)-21 CK(CPK)-905* ALK \nPHOS-65 TOT BILI-0.4\n___ 05:46AM CK-MB-13* MB INDX-1.4 cTropnT-0.05*\n___ 05:46AM CALCIUM-9.2 PHOSPHATE-5.7*# MAGNESIUM-3.4*\n___ 05:46AM OSMOLAL-325*\n___ 05:46AM WBC-17.5* RBC-4.45* HGB-14.0 HCT-40.7 MCV-91# \nMCH-31.4 MCHC-34.4 RDW-12.0\n___ 05:46AM PLT COUNT-489*\n___ 05:46AM ___ PTT-28.8 ___\n___ 03:56AM TYPE-ART PO2-118* PCO2-19* PH-7.20* TOTAL \nCO2-8* BASE XS--18\n___ 03:56AM GLUCOSE-348* LACTATE-12.1* K+-7.3*\n___ 03:56AM freeCa-1.14\n___ 03:33AM URINE HOURS-RANDOM UREA N-519 CREAT-109 \nSODIUM-42 POTASSIUM-37 CHLORIDE-22 TOT PROT-9 PROT/CREA-0.1\n___ 03:33AM URINE U-PEP-NO PROTEIN OSMOLAL-370\n___ 03:33AM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 02:43AM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 02:43AM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-100 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-MOD\n___ 02:43AM URINE RBC-18* WBC-11* BACTERIA-NONE YEAST-NONE \nEPI-<1\n___ 02:43AM URINE MUCOUS-RARE\n___ 02:28AM GLUCOSE-408* UREA N-229* CREAT-27.8* \nSODIUM-124* POTASSIUM-7.8* CHLORIDE-72* TOTAL CO2-5* ANION \nGAP-55*\n___ 02:28AM ALT(SGPT)-25 AST(SGOT)-23 LD(LDH)-300* \nCK(CPK)-753* ALK PHOS-65 TOT BILI-0.2\n___ 02:28AM CK-MB-11* MB INDX-1.5 cTropnT-0.07*\n___ 02:28AM TOT PROT-7.1 ALBUMIN-4.2 GLOBULIN-2.9\n___ 02:28AM OSMOLAL-376*\n___ 02:28AM GLUCOSE-366* K+-7.1*\n___ 12:50AM K+-8.0*\n___ 12:20AM GLUCOSE-344* UREA N-224* CREAT-27.4*# \nSODIUM-125* POTASSIUM-8.9* CHLORIDE-72* TOTAL CO2-6* ANION \nGAP-56*\n___ 12:20AM estGFR-Using this\n___ 12:20AM CK(CPK)-751*\n___ 12:20AM CK-MB-11* MB INDX-1.5 cTropnT-0.06*\n___ 12:20AM CALCIUM-10.1 PHOSPHATE-17.6* MAGNESIUM-6.6*\n___ 12:20AM WBC-22.2*# RBC-4.74 HGB-14.6 HCT-46.5 MCV-98 \nMCH-30.8 MCHC-31.4 RDW-11.8\n___ 12:20AM NEUTS-69 BANDS-4 LYMPHS-16* MONOS-7 EOS-0 \nBASOS-0 ___ METAS-2* MYELOS-2*\n___ 12:20AM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL\n\nImaging:\n\n___ ECG 1244AM: Uncertain atrial mechanism which could be \nsinus with low amplitude P waves versus accelerated junctional \nor idioventricular rhythm or sino-ventricular rhythm. \nIntraventricular conduction delay. Peaked T waves. ST segment \nelevation in lead V1 with right ventricular conduction delay and \nleft anterior fascicular block. Combination of findings is \nstrongly suggestive of hyperkalemia. No previous tracing \navailable for comparison. Clinical correlation is suggested. \n\n___ ECG: Normal sinus rhythm. Non-specific ST-T wave \nabnormalities. \n\n___ CXR: IMPRESSION: Possible mild vascular plethora. Mild \nbibasilar atelectasis. No frank consolidation seen.\n\n___ CT Abdomen/Pelvis: IMPRESSION:\n1. Massively dilated bladder, with mild hydronephrosis and \nhydroureter\nbilaterally.\n2. Sub-2 mm left renal stone.\n\nLab Results on Discharge:\n\n___ 06:25AM BLOOD WBC-10.2 RBC-4.04* Hgb-12.3* Hct-37.6* \nMCV-93 MCH-30.6 MCHC-32.9 RDW-11.8 Plt ___\n___ 06:25AM BLOOD Glucose-167* UreaN-13 Creat-1.2 Na-139 \nK-3.5 Cl-108 HCO3-24 AnGap-11\n___ 06:25AM BLOOD CK(CPK)-694*\n___ 11:15AM BLOOD ALT-17 AST-29 LD(LDH)-210 CK(CPK)-1477* \nAlkPhos-46 TotBili-0.6\n___ 11:15AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 06:25AM BLOOD Calcium-7.7* Phos-2.5* Mg-1.4*\nPrimary Reason for Hospitalization:\n___ male with diabetes, HTN who developed constipation and \nurinary retention likely from BPH and opiate use for new back \npain. Patient was transferred from PCP to the ___ ED, where \nsignificant electrolyte abnormalities were noted. CT \nabdomen/pelvis showed massively distended bladder and bilateral \nhydronephrosis. EKG reported showed "peaked T waves." The renal \nservice was consulted for urgent dialysis, and patient was \ntransferred to MICU for hemodialysis. Post hemodialysis, patient \nwas transferred to the Medicine Service, where his lisinorpil, \nhydrochlorothiazide, statin, and metformin were stopped, in lieu \nof kidney injury. During his time on the Medicine Service, he \nwas given antibiotics for suspected urinary tract infection, \nprovided electrolyte supplementation and fluids, provided a \ndiabetic diet, and monitored for improvement of uremic symptoms, \nkidney function, and acid-base status. Per urology \nrecommendations, the patient was continued with a foley catheter \nthroughout the stay, with the plan of removing the foley 5 days \nafter discharge and following up with urology. \n\nAcute Care:\n\n1. Acute Renal Failure from bladder outlet obstruction:\nPatient presented to the hospital with inability to walk at home \nand with abdominal distension and acute renal failure. CT showed \nmassively distended bladder and bilateral hydronephrosis in the \nsetting of likely BPH and recent use of opiates for back pain. \nFoley catheter was placed to relieve the obstruction and \npatient\'s creatinine trended down from 27.4 on presentation to \n1.2 on discharge. Following relief of the obstruction, patient\'s \nfluid balance was matched with ___ given post-obstructive \ndiuresis which slowed prior to discharge. Foley catheter was \nleft in place to be removed as outpatient with PCP and urology \nfollowup.\n\n2. Hyperkalemia:\nIn the setting of patient\'s acute renal failure his potassium on \npresentation was 8.9. ECG revealed peaked T-waves. He went to \nthe ICU for emergent HD via a femoral line. The patient\'s \npotassium trended down to 3.5. A repeat EKG did not find any \nfurther abnormalities. Lisinopril and HCTZ were held until renal \nfunction improved.\n.\n3. Anion Gap Metabolic Acidosis: Patient presented with a lactic \nacidosis in the setting of renal failure and metformin use. \nMetformin was held and renal abnormalities were corrected. He \nunderwent one episode of HD while his kidneys recovered. The \nanion gap ultimately resolved from 56 to 11, while the bicarb \ntrended up from 6 to 24. He was discharged off metformin. \n. \n4. Uremic Encephalopathy:\nPatient remained oriented to time and person throughout his \nhospital stay but lost orientation to place for 2 days following \ncorrection of uremia. He also was slightly combative when asked \nquestions related to his job, trying to avoid detailed \nquestions. On exam he displayed asterixis and inattentiveness \nwhen asked to state the months of the year backwards. His wife \nendorsed confusion as well. Thiamine and folate supplementation \nwere given if there was an aspect of unknown alcoholism, but \nultimately correction of patient\'s renal abnormalities and \nmonitoring led to patient\'s recovery of orientation and less \nless confusion. By discharge he was A+Ox3, with no asterixis, \nand able to hold the attention to state the months of the year \nbackwards. \n. \n5. Leukocytosis: \nGiven the results of the urine culture and the urinalysis with \nlack of pyuria, the patient remained at low suspicion of urinary \ntract infection, and was thus taken off ceftriaxone, which was \ninitially given for concern of UTI. The patient did not have any \nadverse effects towards withdrawal of antibiotics. The \nleukocytosis ultimately resolved from 22.2 to 10.1.\n. \n6. Elevated CK/CPK/Trop: \nPatient developed elevated CPK during his hospitalization. \nSimvastatin had been on hold since two days prior, and CK-MB and \ntroponin were negative. Ultimately the cause was supected to be \nmild rhabdomyolysis from hypophosphatemia, and CPK was \ndowntrending on discharge with phosphate repletion and fluids. \nSimvastatin decided to be re-started as an outpatient. \n. \nChronic Care:\n \n1. Diabetes:\nThe patient\'s glipizide and metformin were held thoroughout the \nstay, and the patient was continued on Lantus and sliding scale \ninsulin. The patient\'s blood sugars gradually trended down from \n344 to 167 by the end of the stay. \n. \n2. Hypertension: \nThe patient remained normotensive with some intermittent \nelevations of blood pressure throughout the stay. Lisinopril and \nHCTZ were held throughout the stay. \nNormotensive with some intermittent elevations. \n.\nTransitions in Care:\nPatient is discharged with foley catheter in place and should \nhave this removed with voiding trial by his PCP.\nStatin should be re-started as an outpatient.\nPatient should keep his f/u appointment with urologist for \nevaluation of his prostate, and opiates and anticholinergic meds \nshould be avoided until prostate health is managed.'}}
|
{'final_diagnoses': ['acute urinary obstruction', 'acute kidney injury', 'hypertension', 'diabetes'], 'procedures': ['Placement of femoral central line with subsequent removal', 'One episode of hemodialysis', 'foley catheter placement'], 'visit_summary': 'Primary Reason for Hospitalization:\n___ male with diabetes, HTN who developed constipation and \nurinary retention likely from BPH and opiate use for new back \npain. Patient was transferred from PCP to the ___ ED, where \nsignificant electrolyte abnormalities were noted. CT \nabdomen/pelvis showed massively distended bladder and bilateral \nhydronephrosis. EKG reported showed "peaked T waves." The renal \nservice was consulted for urgent dialysis, and patient was \ntransferred to MICU for hemodialysis. Post hemodialysis, patient \nwas transferred to the Medicine Service, where his lisinorpil, \nhydrochlorothiazide, statin, and metformin were stopped, in lieu \nof kidney injury. During his time on the Medicine Service, he \nwas given antibiotics for suspected urinary tract infection, \nprovided electrolyte supplementation and fluids, provided a \ndiabetic diet, and monitored for improvement of uremic symptoms, \nkidney function, and acid-base status. Per urology \nrecommendations, the patient was continued with a foley catheter \nthroughout the stay, with the plan of removing the foley 5 days \nafter discharge and following up with urology. \n\nAcute Care:\n\n1. Acute Renal Failure from bladder outlet obstruction:\nPatient presented to the hospital with inability to walk at home \nand with abdominal distension and acute renal failure. CT showed \nmassively distended bladder and bilateral hydronephrosis in the \nsetting of likely BPH and recent use of opiates for back pain. \nFoley catheter was placed to relieve the obstruction and \npatient\'s creatinine trended down from 27.4 on presentation to \n1.2 on discharge. Following relief of the obstruction, patient\'s \nfluid balance was matched with ___ given post-obstructive \ndiuresis which slowed prior to discharge. Foley catheter was \nleft in place to be removed as outpatient with PCP and urology \nfollowup.\n\n2. Hyperkalemia:\nIn the setting of patient\'s acute renal failure his potassium on \npresentation was 8.9. ECG revealed peaked T-waves. He went to \nthe ICU for emergent HD via a femoral line. The patient\'s \npotassium trended down to 3.5. A repeat EKG did not find any \nfurther abnormalities. Lisinopril and HCTZ were held until renal \nfunction improved.\n.\n3. Anion Gap Metabolic Acidosis: Patient presented with a lactic \nacidosis in the setting of renal failure and metformin use. \nMetformin was held and renal abnormalities were corrected. He \nunderwent one episode of HD while his kidneys recovered. The \nanion gap ultimately resolved from 56 to 11, while the bicarb \ntrended up from 6 to 24. He was discharged off metformin. \n. \n4. Uremic Encephalopathy:\nPatient remained oriented to time and person throughout his \nhospital stay but lost orientation to place for 2 days following \ncorrection of uremia. He also was slightly combative when asked \nquestions related to his job, trying to avoid detailed \nquestions. On exam he displayed asterixis and inattentiveness \nwhen asked to state the months of the year backwards. His wife \nendorsed confusion as well. Thiamine and folate supplementation \nwere given if there was an aspect of unknown alcoholism, but \nultimately correction of patient\'s renal abnormalities and \nmonitoring led to patient\'s recovery of orientation and less \nless confusion. By discharge he was A+Ox3, with no asterixis, \nand able to hold the attention to state the months of the year \nbackwards. \n. \n5. Leukocytosis: \nGiven the results of the urine culture and the urinalysis with \nlack of pyuria, the patient remained at low suspicion of urinary \ntract infection, and was thus taken off ceftriaxone, which was \ninitially given for concern of UTI. The patient did not have any \nadverse effects towards withdrawal of antibiotics. The \nleukocytosis ultimately resolved from 22.2 to 10.1.\n. \n6. Elevated CK/CPK/Trop: \nPatient developed elevated CPK during his hospitalization. \nSimvastatin had been on hold since two days prior, and CK-MB and \ntroponin were negative. Ultimately the cause was supected to be \nmild rhabdomyolysis from hypophosphatemia, and CPK was \ndowntrending on discharge with phosphate repletion and fluids. \nSimvastatin decided to be re-started as an outpatient. \n. \nChronic Care:\n \n1. Diabetes:\nThe patient\'s glipizide and metformin were held thoroughout the \nstay, and the patient was continued on Lantus and sliding scale \ninsulin. The patient\'s blood sugars gradually trended down from \n344 to 167 by the end of the stay. \n. \n2. Hypertension: \nThe patient remained normotensive with some intermittent \nelevations of blood pressure throughout the stay. Lisinopril and \nHCTZ were held throughout the stay. \nNormotensive with some intermittent elevations. \n.\nTransitions in Care:\nPatient is discharged with foley catheter in place and should \nhave this removed with voiding trial by his PCP.\nStatin should be re-started as an outpatient.\nPatient should keep his f/u appointment with urologist for \nevaluation of his prostate, and opiates and anticholinergic meds \nshould be avoided until prostate health is managed.', 'medications_prescribed': ['1. Aspirin Low Dose 81 mg Tablet, Delayed Release (E.C.) Sig: \nOne (1) Tablet, Delayed Release (E.C.) PO once a day.', '2. insulin glargine 100 unit/mL Solution Sig: Twenty (20) units \nSubcutaneous at bedtime.', '3. insulin lispro 100 unit/mL Solution Sig: One (1) injection \nSubcutaneous as directed: as directed by your PCP.', '4. glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day.', '5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '6. benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3 \ntimes a day) as needed for cough.\nDisp:*45 Capsule(s)* Refills:*0*', '7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'F', 'symptoms': 'Morbid obesity', 'medical_history': ['1) hyperlipidemia with elevated triglycerides', '2) history of elevated blood pressures', '3) history of chronic headaches', '4) back pain', '5) history of symptomatic macromastia', '6) mild gastroesophageal reflux with small hiatal hernia', '7) vitamin D deficiency'], 'family_history': None, 'present_illness': '___ is a ___ female referred for the\nreevaluation of gastric restrictive surgery in the treatment and\nmanagement of morbid obesity. She has Class III morbid obesity \nat\n292 today. She is s/p removal of lap band in ___ due too\nstenosis and dysphagia with taking down food and liquid and\npresented to the ED on ___ for subsequent removal of band by\nDr. ___. Her weight at the time of band removal was 218.2\npounds and subsequently has gained significant weight. She now\nwants a sleeve gastrectomy.\n\nShe recently was seen by GI, received an upper endoscope which\nshowed a small hiatal hernia.', 'medications': [{'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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 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': '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': '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 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': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'X1 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': 'Ivermectin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', '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': 'X1 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': 0.0}, {'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}]}, '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': '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': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.010', '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': '1.62', 'valuenum': 1.62, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'THICK AND THIN SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.4', 'valuenum': 53.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.51', 'valuenum': 0.51, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.57', 'valuenum': 2.57, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1.1', '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': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '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': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', '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': '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, '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': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'THIN AND THICK SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': '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': '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': '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': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', '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': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'THIN AND THICK SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': 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': '34.9', 'valuenum': 34.9, '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': '29.0', 'valuenum': 29.0, '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': '87', 'valuenum': 87.0, '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': 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': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, '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': '___'}], 'exams': '___ 0412 Temp: 98 .7 PO BP: 128/76 HR: 69 RR: 18 O2 sat: \n98%\nO2 delivery: RA \nGEN: NAD, A&Ox3\nCV: Regular rate\nPULM: Non-labored breathing on room air \nABD: soft, non-distended, appropriately tender. Surgical\ndressings removed today. Incision sites well coapted, no\nsurrounding erythema or drainage noted, no clinical evidence of\ninfection. \nEXT: WWP.', 'diagnoses': [{'icd_code': '08881', 'desc': 'Lyme Disease'}, {'icd_code': '3207', 'desc': 'Meningitis in other bacterial diseases classified elsewhere'}, {'icd_code': '3510', 'desc': "Bell's palsy"}], 'summary': "___ 02:36PM BLOOD Hct-40.4\n___ 04:30AM BLOOD Hct-36.1\nThe patient presented preoperatively on ___. Patient was \nevaluated by anaesthesia. The patient was taken to the \noperating room for a laparoscopic sleeve gastrectomy for \nobesity. There were no adverse events in the operating room; \nplease see the operative note for details. Pt was extubated, \ntaken to the PACU until stable, then transferred to the ward for \nobservation. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA. Pain was \nvery well controlled. The patient was then transitioned to \ncrushed oral pain medication once tolerating a stage 3 diet. \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. Afterwards, the \npatient was started on a stage 1 bariatric diet, which the \npatient tolerated well. Subsequently, the patient was advanced \nto stage 2, and then stage 3 diet which the patient was \ntolerating on day of 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 \nbariatric stage 3 diet, ambulating, voiding without assistance, \nand pain was well controlled. The patient received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan."}}
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{'final_diagnoses': ['Morbid obesity'], 'procedures': ['laparoscopic sleeve gastrectomy'], 'visit_summary': "The patient presented preoperatively on ___. Patient was \nevaluated by anaesthesia. The patient was taken to the \noperating room for a laparoscopic sleeve gastrectomy for \nobesity. There were no adverse events in the operating room; \nplease see the operative note for details. Pt was extubated, \ntaken to the PACU until stable, then transferred to the ward for \nobservation. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA. Pain was \nvery well controlled. The patient was then transitioned to \ncrushed oral pain medication once tolerating a stage 3 diet. \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. Afterwards, the \npatient was started on a stage 1 bariatric diet, which the \npatient tolerated well. Subsequently, the patient was advanced \nto stage 2, and then stage 3 diet which the patient was \ntolerating on day of 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 \nbariatric stage 3 diet, ambulating, voiding without assistance, \nand pain was well controlled. The patient received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan.", 'medications_prescribed': ['1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild/Fever \nRX *acetaminophen 650 mg/20.3 mL 20 mL by mouth Q6H:PRN Disp \n#*300 Milliliter Refills:*0', '2. Docusate Sodium (Liquid) 100 mg PO BID \nRX *docusate sodium [Stool Softener] 50 mg/5 mL 10 mL by mouth \ntwice a day Disp ___ Milliliter Refills:*0', '3. Famotidine 20 mg PO BID \nRX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0', '4. OxycoDONE Liquid 5 mg PO Q4H:PRN Pain - Moderate \nRX *oxycodone 5 mg/5 mL 5 mL by mouth Q4H:PRN Refills:*0', '5. Multivitamins 1 TAB PO DAILY', '6. 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': 57, 'gender': 'M', 'symptoms': 'Right lower extremity ischemia with\nulceration.', 'medical_history': ['Aneurysm rupture and craniotomy for it in ___ with a residual\naphagia and dense right hemiparesis.', 'Seizure disorder.', 'Venous stasis and leg ulcers.', 'Salpingo-hysterectomy.', 'Right femoral-popliteal bypass in ___ for a\nnonhealing ulcer with underlying arterial insufficiency. The\nreplace of bypass in ___ for continued nonhealing\nulcers.', 'Chronic hepatitis C'], 'family_history': 'non contributary', 'present_illness': 'The patient is a ___ woman\nwith severe peripheral vascular disease who had previously\nundergone an aortobifemoral bypass and a subsequent femoral-\npopliteal bypass graft. She had to have the right femoral-\npopliteal bypass graft removed for infection. She presents\nwith nonhealing ulcers of the right foot. Based on her\nulceration as well as her physical exam, she consented for an\narteriogram and possible angioplasty. Given the previous\naortobifemoral bypass graft, we elected to proceed with a\nleft brachial access.', 'medications': [{'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': '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': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': '___'}, {'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': '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': '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': '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': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', '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': '246', 'valuenum': 246.0, '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': '4.60', 'valuenum': 4.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VSS\nGen: NAD, expressive asphasia is baseline\nCards: reg\nLungs: CTA\nAbd: benign\nBrachial access- without hematoma\nRT lateral and ___ toe ulcerations- Clean and without evidence \nof infection', 'diagnoses': [{'icd_code': '462', 'desc': 'Acute pharyngitis'}, {'icd_code': '4619', 'desc': 'Acute sinusitis, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V7389', 'desc': 'Special screening examination for other specified viral diseases'}, {'icd_code': 'V698'}], 'summary': '___ 06:35AM BLOOD WBC-4.7 RBC-4.69 Hgb-12.7 Hct-38.3 MCV-82 \nMCH-27.0 MCHC-33.0 RDW-15.4 Plt ___\n___ 06:35AM BLOOD Plt ___\n___ 02:00PM BLOOD ___\n___ 06:35AM BLOOD Glucose-129* UreaN-10 Creat-0.7 Na-139 \nK-4.2 Cl-103 HCO3-25 AnGap-15\n___ 06:35AM BLOOD Calcium-8.8 Mg-1.9\nUnderwent uneventful RLE angio/intervention via left brachial \nsheath. Venous access in left femoral.\n1. Ultrasound-guided puncture of left brachial artery.\n2. Ultrasound-guided puncture of left common femoral vein.\n3. Placement of central venous catheter through the left\n common femoral vein.\n4. Placement of catheter into the aortic arch.\n5. Third-order catheterization of right superficial femoral\n artery\n6. Serial arteriogram of the right lower extremity.\n7. Abdominal aortogram.\n8. Percutaneous transluminal angioplasty of right\n superficial femoral artery and right popliteal artery.\nPostoperatively, VSS. Pain controlled. Brachial sheath pulled \nwithout difficulty.\nDiet resumed\n___ VSS No overnight events. Tolerating po. Foley \ndiscontinued. Venous sheath discontinued. Labs stable. \nDischarged to home with day care and ___ for wound care. Home \nmedications resumed including coumadin monitored by Dr. ___'}}
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{'final_diagnoses': ['___ with Ulcer on Right foot now (___) s/p right SFA-pop \nballoon angioplasty', 'PMH: L MCA aneurysm rupture > R hemiparesis & expressive \naphasia, seizure disorder, RLE DVT (___), chronic Hepatitis C \n(due to blood transfusion), htxn, combined PVD and venous stasis', 'PSH: L craniotomy for ruptured aneurysm ___, TAH-BSO, ABF \n(___), R Aortofem graft to AKpop w/ Dacron (___), STSG \nR foot (___), R fem graft to AKpop w/ PTFE (___) c/b \ngraft infection, infected graft excision; R pop a vein \nangioplasty (___)'], 'procedures': ['___ right SFA-pop balloon angioplasty'], 'visit_summary': 'Underwent uneventful RLE angio/intervention via left brachial \nsheath. Venous access in left femoral.\n1. Ultrasound-guided puncture of left brachial artery.\n2. Ultrasound-guided puncture of left common femoral vein.\n3. Placement of central venous catheter through the left\n common femoral vein.\n4. Placement of catheter into the aortic arch.\n5. Third-order catheterization of right superficial femoral\n artery\n6. Serial arteriogram of the right lower extremity.\n7. Abdominal aortogram.\n8. Percutaneous transluminal angioplasty of right\n superficial femoral artery and right popliteal artery.\nPostoperatively, VSS. Pain controlled. Brachial sheath pulled \nwithout difficulty.\nDiet resumed\n___ VSS No overnight events. Tolerating po. Foley \ndiscontinued. Venous sheath discontinued. Labs stable. \nDischarged to home with day care and ___ for wound care. Home \nmedications resumed including coumadin monitored by Dr. ___', 'medications_prescribed': ['1. Pneumococcal 23-ValPS Vaccine 25 mcg/0.5 mL Injectable Sig: \nOne (1) ML Injection ASDIR (AS DIRECTED).', '2. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff \nInhalation Q6H (every 6 hours).', '3. Fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr \nTransdermal Q72H (every 72 hours).', '4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '5. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) \nSpray Nasal DAILY (Daily).', '6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', '7. Phenytoin Sodium Extended 100 mg Capsule Sig: Three (3) \nCapsule PO BID (2 times a day).', '8. Warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily) for 1 months: 1 month only, no refills.\nDisp:*30 Tablet(s)* Refills:*0*', '11. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ6H (every 6 hours) as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', '12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID \n(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': 78, 'gender': 'M', 'symptoms': 'Word finding difficutly', 'medical_history': ['HTN', 'Left ___ s/p 1 burr hole evacuation ___ with Dr. ___.'], 'family_history': 'non contributory', 'present_illness': '___ yo M recently admitted to Neurosurgery s/p Burr hole\nevacuation Left ___ ___ who was discharged to rehab. Today\naround 3pm he developed word finding difficulty and confusion \nand\npt was sent to ED for evaluation. Pt is unable to clearly state\nevents due to aphasia. Currently he endorses mild HA.', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', '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 via patient discharge', 'route': 'SC', 'frequency': 'Q24H', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 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': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.021', '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. 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': '36.6', 'valuenum': 36.6, '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': '31.8', 'valuenum': 31.8, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, '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': '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.7', '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ON ADMISSION\n=============\nGen: WD/WN, comfortable, NAD.\nHEENT: incision healing well, staples in place\n\nMild right facial, otherwise CN intact\nMild right drift, Right Delt 4+/5 otherwise upper extremities \n___\nRight AT is slow but full. ___ strength bilat ___\nPUpils equal and brisk\nSignificant word finding difficulties, able only to answer \nsimple\nyes/no, frequent paraphrasic errors and word substitutions. \nNames pen but has difficulty with phone. Cannot name ID/badge\n\nON DISCHARGE\n============\nMental status: Awake, alert, cooperative with exam. Normal \naffect.\nOrientation: Oriented to person, place and date.\nLanguage: Fluent without dysarthria or paraphasic errors. \n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4 to 3 mm \nbilaterally. \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. Moves all extremities full strength ___. No pronator \ndrift.', 'diagnoses': [{'icd_code': 'S82042A', 'desc': 'Displaced comminuted fracture of left patella, initial encounter for closed fracture'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'S52122A', 'desc': 'Displaced fracture of head of left radius, initial encounter for closed fracture'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'W010XXA', 'desc': 'Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter'}, {'icd_code': 'Y92488', 'desc': 'Other paved roadways as the place of occurrence of the external cause'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}], 'summary': '___ NCHCT\nNo significant change in overall size of postoperative left \ncerebral subdural collection containing hypodense fluid and gas \nwith unchanged mass effect and shift of 12 mm midline structures \nto the right. \n\n___ MRI brain with and without contrast\n1. Unchanged size and local mass effect of a large left \nfrontoparietotemporal subdural fluid after hematoma evacuation. \n2. Leptomeningeal enhancement in the left hemisphere that may be \na consequence of prior hemorrhage. However, the possibility of \ninfection should be considered. \n3. No acute infarction or masses. \n\n___ NCHCT\nInterval decrease in size of the left frontoparietotemporal \nacute on \nchronic subdural hematoma. \n2. Stable shift of midline structures, measuring up to 1.2 cm. \n\n___ NCHCT \n1. Interval removal of left frontal SEPS hardware, \n2. Grossly stable approximately 1.9 cm thick left acute on \nchronic subdural hematoma with focal hyperdensity that \ndemonstrates new hyperdense component suggestive of bone \nfragment versus surgical hardware with adjacent acute blood \nproducts. Recommend attention on followup imaging and \ncorrelation with neurologic exam. \n3. Stable approximate 1.2 cm left-to-right midline shift. \n4. Evolving postsurgical changes related to prior left \nfrontoparietotemporal craniotomy. \n \nRECOMMENDATION(S): Grossly stable approximately 1.9 cm thick \nleft acute on chronic subdural hematoma with focal hyperdensity \nthat demonstrates new \nhyperdense component suggestive of bone fragment versus surgical \nhardware with adjacent acute blood products. Recommend attention \non followup imaging and correlation with neurologic exam. \n\n___ NCHCT\n1. Expected postsurgical changes related to interval craniotomy \nand evacuation of chronic left subdural hematoma. No evidence \nof postsurgical complications. \n2. Residual, posterior component of the left subdural hematoma \nis smaller, now measuring up to 1.6 cm. Interval decrease in \nmass effect and rightward midline shift.\nMr. ___ was admitted from rehab on ___ with word finding \ndifficulties. He had a NCHCT which demonstrated no significant \nchange in the size of postoperative cerebral subdural with 12 mm \nmidline structures to the right. \n\nOn ___, the patient had noted improvement in his speech. His \nKeppra dose was increased to 750mg BID. \n\nOn ___, the patient had a left sided SEPS placed at the bedside \nunder conscious sedation. He remained neurologically stable \nafter placement. He underwent an MRI of the head which was \nnegative for any evidence of infarct. Infection was considered \nunlikely as leptomeningeal enhancement was secondary to old \nblood layering. \n\nOn ___, a NCHCT was completed to evaluate the efficacy of the \nSEPS due to poor bulb output. The NCHCT showed an unchanged \namount of SDH blood. A re-exploration of SEPS was unsuccessful \ndue to no drainage and the device was discontinued. The patient \nwas febrile to 101.3. Blood and urine cultures were ordered. \n\nOn ___, the patient remained neurologically stable. Blood and \nurine cultures are pending. A repeat head CT showed a stable \nleft SDH with midline shift. The patient went to the OR for a \ncranietomy for evacuation of the L SDH. \n\nOn ___, the patient remained neurologically stable. His drain \nremained in place and he was transferred to the floor. \n\n___, Mr. ___ drain was discontinued. He was evaluated by \nphysical therapy and experienced some orthostatic hypotension. \n\nOn ___, the patient remained neurologically and hemodynamically \nstable. He was evaluated by physical therapy and continued to \nbe orthostatic. His repeat NCHCT was stable. He was discharged \nto rehab in stable condition.'}}
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{'final_diagnoses': ['Cerebral Compression', 'Subdural hematoma'], 'procedures': ['___ SEPS', '___ Re-exploration of SEPS', '___ craniotomy for evacuation of L ___'], 'visit_summary': 'Mr. ___ was admitted from rehab on ___ with word finding \ndifficulties. He had a NCHCT which demonstrated no significant \nchange in the size of postoperative cerebral subdural with 12 mm \nmidline structures to the right. \n\nOn ___, the patient had noted improvement in his speech. His \nKeppra dose was increased to 750mg BID. \n\nOn ___, the patient had a left sided SEPS placed at the bedside \nunder conscious sedation. He remained neurologically stable \nafter placement. He underwent an MRI of the head which was \nnegative for any evidence of infarct. Infection was considered \nunlikely as leptomeningeal enhancement was secondary to old \nblood layering. \n\nOn ___, a NCHCT was completed to evaluate the efficacy of the \nSEPS due to poor bulb output. The NCHCT showed an unchanged \namount of SDH blood. A re-exploration of SEPS was unsuccessful \ndue to no drainage and the device was discontinued. The patient \nwas febrile to 101.3. Blood and urine cultures were ordered. \n\nOn ___, the patient remained neurologically stable. Blood and \nurine cultures are pending. A repeat head CT showed a stable \nleft SDH with midline shift. The patient went to the OR for a \ncranietomy for evacuation of the L SDH. \n\nOn ___, the patient remained neurologically stable. His drain \nremained in place and he was transferred to the floor. \n\n___, Mr. ___ drain was discontinued. He was evaluated by \nphysical therapy and experienced some orthostatic hypotension. \n\nOn ___, the patient remained neurologically and hemodynamically \nstable. He was evaluated by physical therapy and continued to \nbe orthostatic. His repeat NCHCT was stable. He was discharged \nto rehab in stable condition.', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN pain or fever > 101.3', '2. Acetaminophen-Caff-Butalbital ___ TAB PO Q8H:PRN headache', '3. Artificial Tears ___ DROP BOTH EYES PRN Dry Eye', '4. Bisacodyl 10 mg PO/PR DAILY', '5. Calcium Carbonate 500 mg PO QID:PRN Indigestion', '6. Docusate Sodium 100 mg PO BID', '7. LevETIRAcetam 750 mg PO BID', '8. Omeprazole 20 mg PO DAILY', '9. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain', '10. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '11. Senna 17.2 mg PO QHS', '12. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 7 Days', '13. Tamsulosin 0.4 mg PO QHS']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 44, 'gender': 'M', 'symptoms': 'lower extremity swelling', 'medical_history': ['OB:\n-TAB x 6', 'GYN hx\nLMP in ___ has not had bleeding since her TAB in ___\nMenarche in teens\nRegular menses q month, "normal flow" using ~3 tampons/ day. \nDenies heavy bldg/clots. Some cramping.\nLast pap ___, normal, denies h/o abn Paps\nDenies h/o STI\'s\nnot using regular contraception, in monogamous relationship with\nboyfriend\nhas known she has had fibroids for a long time but has never \nbeen\nsymptomatic', 'PMH: denies', 'PSH: D&C x ~6'], 'family_history': 'denies FH of uterine, ovarian, cervix, and breast CA. \nSisters and mother all with fibroids', 'present_illness': "___ yo G6P0 presents for an abdominal myomectomy for symptomatic \nfibroids. She was originally seen in the ED on ___ when she \npresented for marked ___ swelling and found to have a large \nfibroid uterus compressing bilateral ureters and iliac vessels. \nShe is also s/p TAB on ___ and incidentally found to have \nretained POC's on pelvic u/s. She was discharged home with \nvaginal cytotec at that time. She was seen in our clinic by Dr. \n___ counseled her on her options and was presented at \nsurgical committee. She is here for her pre-op visit to discuss \nher upcoming surgery. \n\nShe reports that her ___ swelling has markedly improved and she \nnotices that it is now very subtle. Her urinary frequency has \nalso resolved. She denies vaginal bleeding, fevers or pelvic \npain/pressure. She denies CP/SOB. Other than the ___ swelling \nthat she developed, she states that her fibroids have never been \nbothersome to her and she currently is asymptomatic and feeling \nwell.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': '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': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'PRN', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'X1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Eptifibatide', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Eptifibatide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Eptifibatide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '65.1', 'valuenum': 65.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 639.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.19, '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': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '236', 'valuenum': 236.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.02', 'valuenum': 5.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 596.0, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 240.0, 'valueuom': 'mg/dL', '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': '3.9', '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': '___', 'valuenum': 0.92, '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, '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': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '264', 'valuenum': 264.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.58', 'valuenum': 5.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '___', 'valuenum': 194.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.47, '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': '41.8', 'valuenum': 41.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '5.30', 'valuenum': 5.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '9.2', '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': '___', 'valuenum': 143.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 0.37, '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.33', 'valuenum': 5.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', '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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'at pre-op visit ___ by Dr. ___:\n\nBP: 100/70. Weight: 140. BMI: 21.9.\nAppears comfortable, in NAD\nRRR\nCTA B\nAbd soft nontender, nondistended, Uterine fundus palpable ___ FB\nbelow umbilicus\nPelvic (today): cervix displaced anteriorly by a large, firm \nmass\nposteriorly, mass is nonmobile; moderate TTP when palpating\nposterior mass; uterus is about 16 weeks size, slightly mobile.', 'diagnoses': [{'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'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'}], 'summary': '___ 04:10PM BLOOD UreaN-11 Creat-0.8\n___ 09:41AM BLOOD UreaN-10 Creat-0.9\n___ 09:41AM BLOOD HCG-11\nOn ___, Ms. ___ was admitted after an uncomplicated \nabdominal myomectomy for symptomatic fibroid uterus. Please \nrefer to operative report for details of the procedure. Her \npost-operative course was uncomplicated. By POD1, she was \ntolerating PO, voiding spontaneously, pain was controlled with \noral medications, and she was ambulating independently without \ndifficulty. She was then discharged home in good condition.'}}
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{'final_diagnoses': ['fibroid uterus'], 'procedures': ['open abdominal myomectomy'], 'visit_summary': 'On ___, Ms. ___ was admitted after an uncomplicated \nabdominal myomectomy for symptomatic fibroid uterus. Please \nrefer to operative report for details of the procedure. Her \npost-operative course was uncomplicated. By POD1, she was \ntolerating PO, voiding spontaneously, pain was controlled with \noral medications, and she was ambulating independently without \ndifficulty. She was then discharged home in good condition.', 'medications_prescribed': ['1. oxycodone-acetaminophen ___ mg Tablet Sig: One (1) Tablet \nPO Q4H (every 4 hours) as needed for pain.\nDisp:*45 Tablet(s)* Refills:*0*', '2. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.\nDisp:*60 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*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 31, 'gender': 'M', 'symptoms': 'L shoulder pain', 'medical_history': ['Fibroids', 'Chronic cough', 'Tobacco', 'Paroxysmal atrial fibrillation s/p cardioversion ___ ', 'Hypertension', 'Obesity', 'Seropositive rheumatoid arthritis (followed by Dr. ___ \non certolizumab)', 'Type B aortic dissection'], 'family_history': 'No premature coronary artery disease or sudden\ndeath.', 'present_illness': '___ h/o RA (on prednisone and Actemra), penetrating\natherosclerotic ulcers of aortic arch and descending aorta (with\nintramural hematoma), afib on anticoagulation, HTN, who \npresented\nwith L shoulder pain being referred in for abnormal imaging\nfindings of multiple rim enhancing lesions in the L glenohumeral\njoint. \n\nShe had a surveillance CTA for her aortic disease that showed\nincidental finding in L shoulder as described, of multiple\nrim-enhancing lesions in the L glenohumeral joint, concering for\nabscess vs. necrotic malignancy. \n\nShe has had L shoulder pain for months. In ___ pt reports\nshe was seen in the ___ ED for this pain, with normal workup\nand films. she tried rehab but it did not help the pain. she\nreports L shoulder pain has been progressive since then. Pain\nlimits her ability to use the L arm in daily life. She denies\nfever, chills, numbness/weakness or tingling in the hand, or\nshooting pain down the hand. \n\nIn the ED:\nInitial vital signs were notable for: 96.3, 72, 158/90, 18, 100%\nRA \n\nLabs were notable for:\n141 ___ AGap=16 \n-------------< \n4.0 22 0.7 \n\n6.6 11.2 273 \n >-----< \n 35.0 \n \n- CRP: 37.1\n\nStudies performed include:\n- GLENO-HUMERAL SHOULDER (W/ Y VIEW) LEFT ___ \nNo acute fracture or dislocation.\n- MRI Shoulder W&W/O Contrast Left - ordered, not yet performed \n\n\nPatient was given:\n___ 18:00 IV HYDROmorphone (Dilaudid) 1 mg \n___ 20:49 IV HYDROmorphone (Dilaudid) 1 mg \n\nConsults:\n- Ortho: no signs of acute infection at this time; however\ndifferential does include infectious abscesses or\nnecrotic malignancy, or potentially intra-muscular hematomas (as\nthe patient is on anticoagulation). MRI with gadolinium would be\nthe best modality to further characterize these lesions. From an\northopaedic surgery standpoint, aspiration of the L glenohumeral\njoint is not recommended at this time. Pending the results of\nMRI, consider aspiration of the most strategically approachable\nlesions by ___ for culture data to guide possible antimicrobial\ntherapy if infection is suggested by MRI.\n\nVitals on transfer: 98.9, 77, 133/82, 18, 98% RA \n\nUpon arrival to the floor, patient reports history as above. her\nL shoulder pain is much improved now after pain meds in the ED;\nshe has not felt this pain free in months. Otherwise denies f/c,\nCP. Has some SOB that is somewhat increased from baseline, for\nwhich at her recent cardiology apt she was instructed to trial\nLasix 20 daily to see if it improves SOB. She reports having ___\nthat she says is baseline.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cetirizine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 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}]}, 'clinical_findings': {'labs': [{'value': '19.7', 'valuenum': 19.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, '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': '35.0', 'valuenum': 35.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.21', 'valuenum': 2.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70.8', 'valuenum': 70.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '29', 'valuenum': 29.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, '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': '89', 'valuenum': 89.0, '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': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.18', 'valuenum': 2.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '68.4', 'valuenum': 68.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MOD*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 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': '1.010', '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': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '255', 'valuenum': 255.0, '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': '2.06', 'valuenum': 2.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.47', 'valuenum': 0.47, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67.4', 'valuenum': 67.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, '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': '90', 'valuenum': 90.0, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '___', '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 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'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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', 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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': 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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, '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': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '253', 'valuenum': 253.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.2', 'valuenum': 21.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.02', 'valuenum': 2.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.39, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'verified by dilution.'}, {'value': '___', 'valuenum': 19.9, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63.7', 'valuenum': 63.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, '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': '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': 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': 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': '32', 'valuenum': 32.0, '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': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.2, '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': 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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.03', 'valuenum': 2.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.35', 'valuenum': 0.35, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '68.4', 'valuenum': 68.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '19', 'valuenum': 19.0, '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': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '<10*.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '961', 'valuenum': 961.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.49', 'valuenum': 2.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65.1', 'valuenum': 65.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '36', 'valuenum': 36.0, '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': '925', 'valuenum': 925.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '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', 'valuenum': 40.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n======================\nVITALS: 98.2PO, 116 / 80R Sitting, 68, 18, 94 Ra \nGENERAL: Alert and interactive. In no acute distress.\nHEENT: NCAT. Sclera anicteric and without injection. \nNECK: supple \nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No\nmurmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or\nrales. No increased work of breathing.\nABDOMEN: soft, non distended, non-tender to deep palpation in \nall\nfour quadrants \nEXTREMITIES: edema at L ankle non-pitting (baseline per notes),\nRLE without edema. L shoulder without obvious deformity. L\nshoulder with active ROM to upwards of 90 degrees of flexion and\nabduction, limited by pain. motor strength ___ in BUE, SILT in\nBUE. TTP diffusely of L shoulder, more around AC joint. \nSKIN: Warm. No rash.\nNEUROLOGIC: CN2-12 intact. ___ strength throughout. Normal\nsensation. Gait is normal. AOx3.\n\nDISCHARGE PHYSICAL EXAM:\n========================\nGENERAL: Alert and interactive, intermittently frustrated.\nHEENT: NCAT. Sclera anicteric and without injection. \nCARDIAC: RRR, audible S1 and S2 without murmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or\nrales. No increased work of breathing.\nABDOMEN: Soft, non-distended, non-tender to deep palpation in \nall\nfour quadrants.\nEXTREMITIES: Non-pitting edema of L ankle (apparently at\nbaseline), RLE without edema. L shoulder without obvious\ndeformity, erythema, or warmth but ROM with abduction/adduction\nand internal/external rotation limited by pain.', 'diagnoses': [{'icd_code': 'D5700', 'desc': 'Hb-SS disease with crisis, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}], 'summary': 'ADMISSION LABS: \n==============\n___ 05:50PM BLOOD WBC-6.6 RBC-4.63 Hgb-11.2 Hct-35.0 \nMCV-76* MCH-24.2* MCHC-32.0 RDW-14.6 RDWSD-38.8 Plt ___\n___ 05:50PM BLOOD Plt ___\n___ 05:50PM BLOOD Glucose-100 UreaN-12 Creat-0.7 Na-141 \nK-4.0 Cl-103 HCO3-22 AnGap-16\n\nCTA CHEST Study Date of ___ \n1. Penetrating ulcers of the aortic arch and descending thoracic\naorta are unchanged compared to CTA of the torso from ___. \n2. Fusiform descending thoracic aortic aneurysm is unchanged. \nFusiform infrarenal abdominal aortic aneurysm is mildly\nincreased, measuring 4.0 cm previously 3.7 cm. \n3. Stable fusiform right common iliac artery aneurysm and \nectasia\nof the left common iliac artery. \n4. Multiple rim enhancing fluid collections about the left\nglenohumeral joint measure up to 5.6 cm. This finding is\nnonspecific, and favors a glenohumeral joint effusion with\nsynovitis. Clinical correlation is recommended, and MRI of the\nshoulder with and without gadolinium may be performed as\nclinically indicated. \n5. New 4 mm pulmonary nodule in the left upper lobe. Attention\non follow-up or with dedicated chest CT in ___ year (given\nbackground emphysema) is recommended. \n \nRECOMMENDATION(S): \n1. Consider left shoulder MRI with and without gadolinium. \n2. Attention to a 4 mm left upper lobe pulmonary nodule on\nfollow-up CTA, or \nwith dedicated chest CT in ___ year. \n\n___ MRI shoulder\n1. Small to moderate glenohumeral joint effusion, communicating \nwith the \nsubscapular recess and biceps tendon sheath, prominent \ndistention of the \nsubcoracoid bursa, with findings of active synovitis and pannus, \n\nintra-articular "rice bodies", overall favoring the history of \nrheumatoid \narthritis. However, if there is high clinical suspicion for \noverlying \ninfection/tuberculosis, joint/bursal aspiration for definitive \ndiagnosis is suggested. \n \n2. Small to moderate interstitial and partial-thickness \narticular sided tears of the subscapularis, supraspinatus and \ninfraspinatus, on mild background \ntendinosis. \n\nDISCHARGE LABS:\n===============\n___ 05:00AM BLOOD WBC-6.2 RBC-4.16 Hgb-10.1* Hct-31.2* \nMCV-75* MCH-24.3* MCHC-32.4 RDW-14.1 RDWSD-37.5 Plt ___\n___ 05:00AM BLOOD Plt ___\n___ 05:00AM BLOOD UreaN-10 Creat-0.5 Na-145 K-4.5 Cl-106 \nHCO3-23 AnGap-16\n___ 05:00AM BLOOD Calcium-9.3 Phos-4.0 Mg-1.___\nwith history of seropositive RA (on prednisone and \ntocilizumab), type B aortic dissection with intramural hematoma, \nafib on anticoagulation, and HTN who presented with chronic L \nshoulder pain and findings of L glenohumeral joint effusion, \nsynovitis, and rotator cuff tears. She underwent joint aspirate \nwith findings of inflammatory fluid and negative cultures, most \nconsistent with ongoing rheumatoid arthritis. She received IM \nDepo Medrol for her L shoulder inflammation and pain, and her \nsystemic steroids were increased with plan for taper.\n\nACUTE ISSUES:\n=============\n#L glenohumeral joint effusion, synovitis, and rotator cuff \ntears s/p aspiration\n#L shoulder pain\nPatient was incidentally found to have rim-enhancing lesions in \nthe L glenohumeral joint on CTA (performed for evaluation of \nknown atherosclerotic aortic lesions), measuring up to 5.6 cm, \ninitially concerning for infection vs malignancy vs necrosis. \nMRI on admission, however, demonstrated joint effusion and \nsynovitis with rice bodies, as well as rotator cuff tears. She \nunderwent joint aspiration showing inflammatory fluid with >40k \nWBC, 90% PMNs, negative gram stain/AFB, and negative \nbacterial/fungal cultures. The etiology of her shoulder \npathology was thought to be a rheumatoid arthritis flare with \nrotator tendinitis +/- adhesive capsulitis. She was seen by \nRheumatology in-house, who recommended consideration of IV \ntocilizumab infusions (patient is currently self-administering \nSQ injections) for better control of her RA. Given ongoing \nshoulder pain, she also received IM Depo Medrol 60mg, and her \nprednisone regimen was increased to 15mg qd with plan to taper \nto original 5mg qd dosing over two weeks. She was discharged on \nher home Percocet PRN regimen. She is scheduled to follow up \nwith her outpatient rheumatologist (Dr. ___ at ___) ___ and \nwith ___ Orthopedics.\n\nMore than 30 minutes were spent preparing this discharge\n\nCHRONIC ISSUES:\n===============\n___ edema\nPatient was recently started on PO Lasix 20mg qd by her \ncardiologist for c/f mild volume overload. She appeared \neuvolemic on exam during her admission and has no documented h/o \nCHF. She was continued on home Lasix here.\n\n#Tobacco use disorder\n- continued nicotine patch qd\n\n#Afib\n- rate control: continued home metoprolol tartrate 150mg BID\n- AC: continued home apixaban 5mg BID\n\n#HTN \n- continued home imdur 120mg qd\n- continued home lisinopril 20mg qd\n\n#Rheumatoid arthritis\n- continued home prednisone 5mg qd\n- receiving tocilizumab as outpatient\n\n#GERD \n- continued home PPI\n\nTRANSITIONAL ISSUES:\n====================\n[] Please consider changing SQ tocilizumab regimen to IV \nformulation to ensure more consistent dosing. Patient has \npreviously declined IV infusions but may be more amenable and \nwill ask about this option at her next Rheumatology follow-up.\n[] Please consider intervention for rotator cuff tears as \nappropriate.\n[] Please follow up on final aspirate culture results.\n\nContact: ___ (daughter), ___ \nFull Code'}}
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{'final_diagnoses': ['L shoulder synovitis and effusion secondary to RA', 'L shoulder rotator cuff tears', '___ edema', 'Atrial fibrillation', 'HTN', 'Rheumatoid arthritis'], 'procedures': ['L glenohumeral joint aspiration'], 'visit_summary': 'with history of seropositive RA (on prednisone and \ntocilizumab), type B aortic dissection with intramural hematoma, \nafib on anticoagulation, and HTN who presented with chronic L \nshoulder pain and findings of L glenohumeral joint effusion, \nsynovitis, and rotator cuff tears. She underwent joint aspirate \nwith findings of inflammatory fluid and negative cultures, most \nconsistent with ongoing rheumatoid arthritis. She received IM \nDepo Medrol for her L shoulder inflammation and pain, and her \nsystemic steroids were increased with plan for taper.\n\nACUTE ISSUES:\n=============\n#L glenohumeral joint effusion, synovitis, and rotator cuff \ntears s/p aspiration\n#L shoulder pain\nPatient was incidentally found to have rim-enhancing lesions in \nthe L glenohumeral joint on CTA (performed for evaluation of \nknown atherosclerotic aortic lesions), measuring up to 5.6 cm, \ninitially concerning for infection vs malignancy vs necrosis. \nMRI on admission, however, demonstrated joint effusion and \nsynovitis with rice bodies, as well as rotator cuff tears. She \nunderwent joint aspiration showing inflammatory fluid with >40k \nWBC, 90% PMNs, negative gram stain/AFB, and negative \nbacterial/fungal cultures. The etiology of her shoulder \npathology was thought to be a rheumatoid arthritis flare with \nrotator tendinitis +/- adhesive capsulitis. She was seen by \nRheumatology in-house, who recommended consideration of IV \ntocilizumab infusions (patient is currently self-administering \nSQ injections) for better control of her RA. Given ongoing \nshoulder pain, she also received IM Depo Medrol 60mg, and her \nprednisone regimen was increased to 15mg qd with plan to taper \nto original 5mg qd dosing over two weeks. She was discharged on \nher home Percocet PRN regimen. She is scheduled to follow up \nwith her outpatient rheumatologist (Dr. ___ at ___) ___ and \nwith ___ Orthopedics.\n\nMore than 30 minutes were spent preparing this discharge\n\nCHRONIC ISSUES:\n===============\n___ edema\nPatient was recently started on PO Lasix 20mg qd by her \ncardiologist for c/f mild volume overload. She appeared \neuvolemic on exam during her admission and has no documented h/o \nCHF. She was continued on home Lasix here.\n\n#Tobacco use disorder\n- continued nicotine patch qd\n\n#Afib\n- rate control: continued home metoprolol tartrate 150mg BID\n- AC: continued home apixaban 5mg BID\n\n#HTN \n- continued home imdur 120mg qd\n- continued home lisinopril 20mg qd\n\n#Rheumatoid arthritis\n- continued home prednisone 5mg qd\n- receiving tocilizumab as outpatient\n\n#GERD \n- continued home PPI\n\nTRANSITIONAL ISSUES:\n====================\n[] Please consider changing SQ tocilizumab regimen to IV \nformulation to ensure more consistent dosing. Patient has \npreviously declined IV infusions but may be more amenable and \nwill ask about this option at her next Rheumatology follow-up.\n[] Please consider intervention for rotator cuff tears as \nappropriate.\n[] Please follow up on final aspirate culture results.\n\nContact: ___ (daughter), ___ \nFull Code', 'medications_prescribed': ['Nicotine Patch 21 mg/day TD DAILY \nRX *nicotine 21 mg/24 hour once a day Disp #*30 Patch \nRefills:*0 ', 'PredniSONE 15 mg PO DAILY Duration: 6 Days \nRX *prednisone 5 mg 3 tablet(s) by mouth once a day Disp #*18 \nTablet Refills:*0 ', 'PredniSONE 10 mg PO DAILY Duration: 7 Days \nStart 10mg dose on ___ and continue taking for 7 days through \n___. \nTapered dose - DOWN \nRX *prednisone 5 mg 2 tablet(s) by mouth once a day Disp #*14 \nTablet Refills:*0 ', 'Tocilizumab 162 /0.9 mg IV AS PATIENT DIRECTED ', 'Apixaban 5 mg PO BID ', 'Atorvastatin 40 mg PO QPM ', 'Furosemide 20 mg PO DAILY:PRN ___ ', 'HYDROcodone-acetaminophen ___ mg oral Q4H:PRN ', 'Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY ', 'Lisinopril 20 mg PO DAILY ', 'Metoprolol Tartrate 150 mg PO BID ', 'Omeprazole 20 mg PO BID']}
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